Lipid-Lowering Efficacy and Safety of Fenofibrate and Gemfibrozil in Patients Undergoing Dialysis: A Retrospective Cohort Analysis
Sathit Kurathong, MD1, Viroonrat Trapcharoen, MD1, Solos Jaturapisanukul, MD1, Tanun Ngamvichukorn, MD1, Wanjak Pongsittisak, MD1, Thananda Trakarnvanich, MD1
Affiliation : 1Renal Division, Department of Internal Medicine. Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Objective: Current clinical guidelines advocate the use of statins for the management of dyslipidemia in patients with chronic kidney disease (CKD) who are not yet on dialysis, but not those on dialysis, leading to uncertainty regarding optimal lipid-lowering strategies in this population. Recently, fibrates have emerged as a therapeutic option for patients with advanced CKD. However, their safety and efficacy in patients undergoing dialysis remain controversial. Therefore, the present study aimed to evaluate the lipid-lowering effects and safety of fenofibrate and gemfibrozil in patients with CKD undergoing dialysis.
Materials and Methods: This was a retrospective study including patients with CKD undergoing dialysis who received fenofibrate or gemfibrozil between January 2012 and December 2018. Patients receiving concomitant lipid-modifying therapy and those with unstable clinical conditions were excluded from the study. Lipid levels were assessed before and 6 to 12 months after fibrate therapy.
Results: A total of 84 patients undergoing dialysis who received fibric acid derivatives (gemfibrozil, n=58; fenofibrate, n=26) were included in the present study. Both fenofibrate and gemfibrozil effectively reduced triglyceride levels. The gemfibrozil group showed a 37% reduction, whereas the fenofibrate group showed a 28% reduction, without a statistically significant difference between the groups (p=0.24). Cholesterol reduction was modest in both groups, without a statistically significant difference between the two groups. No severe adverse effects were reported. Muscle pain was the most prevalent side effect. However, it did not lead to substantial discontinuation rates.
Conclusion: Fibrate therapy, particularly low-dose fenofibrate, is effective and safe for managing dyslipidemia in patients with CKD undergoing dialysis and offers a potential alternative to statins, which have minimal benefits for this population. Further prospective studies are needed to confirm these findings and refine treatment guidelines for dyslipidemia in patients with end-stage kidney disease.
Received 10 October 2024 | Revised 26 February 2025 | Accepted 12 March 2025
Keywords : Chronic kidney disease; Fenofibrate; Gemfibrozil; Dialysis
