Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Front Endocrinol (Lausanne). 2024 Feb 13;15:1333553. doi: 10.3389/fendo.2024.1333553. eCollection 2024.
Hypertriglyceridemia is the most prevalent dyslipidemia in patients with chronic kidney disease (CKD). However, research about fibrate treatment in CKD patients is limited, and assessing its benefits becomes challenging due to the frequent concurrent use of statins. Thus, this study is aimed to investigate the role of fibrate in CKD stage 3 patients with hypertriglyceridemia who did not receive other lipid-lowering agents.
This study enrolled patients newly diagnosed CKD3 with LDL-C<100mg/dL and had never received statin or other lipid-lowering agents from Chang Gung Research Database. The participants were categorized into 2 groups based on the use of fibrate: fibrate group and non-fibrate group (triglyceride >200mg/dL but not receiving fibrate treatment). The inverse probability of treatment weighting was performed to balance baseline characteristics.
Compared with the non-fibrate group (n=2020), the fibrate group (n=705) exhibited significantly lower risks of major adverse cardiac and cerebrovascular events (MACCEs) (10.4% vs. 12.8%, hazard ratios [HRs]: 0.69, 95% confidence interval [CI]: 0.50 to 0.95), AMI (2.3% vs. 3.9%, HR: 0.52, 95% CI: 0.37 to 0.73), and ischemic stroke (6.3% vs. 8.0%, HR: 0.67, 95% CI: 0.52 to 0.85). The risk of all-cause mortality (5.1% vs. 4.5%, HR: 1.09, 95% CI: 0.67 to 1.79) and death from CV (2.8% vs. 2.3%, HR: 1.07, 95% CI: 0.29 to 2.33) did not significantly differ between the 2 groups.
This study suggests that, in moderate CKD patients with hypertriglyceridemia but LDL-C < 100mg/dL who did not take other lipid-lowering agents, fibrates may be beneficial in reducing cardiovascular events.
高甘油三酯血症是慢性肾脏病（CKD）患者最常见的血脂异常。然而，由于经常同时使用他汀类药物，关于 CKD 患者使用贝特类药物治疗的研究受到限制，评估其益处变得具有挑战性。因此，本研究旨在探讨贝特类药物在未接受其他降脂药物治疗的 CKD3 期伴高甘油三酯血症患者中的作用。
本研究从长庚研究数据库中招募了新诊断为 CKD3 期的患者，这些患者的 LDL-C<100mg/dL，且从未接受过他汀类药物或其他降脂药物治疗。根据是否使用贝特类药物，将患者分为 2 组：贝特组（n=705）和非贝特组（甘油三酯>200mg/dL 但未接受贝特类药物治疗）（n=2020）。采用逆概率治疗加权法平衡基线特征。
与非贝特组（n=2020）相比，贝特组（n=705）的主要不良心脑血管事件（MACCEs）（10.4%比 12.8%，危险比[HR]：0.69，95%置信区间[CI]：0.50 至 0.95）、急性心肌梗死（AMI）（2.3%比 3.9%，HR：0.52，95%CI：0.37 至 0.73）和缺血性卒中（6.3%比 8.0%，HR：0.67，95%CI：0.52 至 0.85）的风险显著降低。两组之间全因死亡率（5.1%比 4.5%，HR：1.09，95%CI：0.67 至 1.79）和心血管死亡率（2.8%比 2.3%，HR：1.07，95%CI：0.29 至 2.33）无显著差异。
本研究表明，在未服用其他降脂药物的中重度 CKD 伴高甘油三酯血症但 LDL-C<100mg/dL 的患者中，贝特类药物可能有益于降低心血管事件风险。
