Fenofibrate Delays the Need for Dialysis and Reduces Cardiovascular Risk among Patients with Advanced CKD

Context Fenofibrate provides limited cardiovascular (CV) benefits in the general population; however, little is known about its benefit among advanced chronic kidney disease (CKD) patients. Objective This study compared outcomes among advanced CKD patients treated with fenofibrate, statins, a combination of both, and none of these. Design National cohort study. Setting Taiwan's National Health Insurance Research Database. Patients Aged >20 years with advanced CKD were identified and further divided into 4 groups according to treatment. The inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Intervention Patients received fenofibrate, statins, a combination of fenofibrate and statins, or none of these in the 3 months preceding the advanced CKD date. Main outcome measures All-cause mortality, CV death, and incidence of permanent dialysis. Results The fenofibrate and statin groups exhibited a lower risk of CV death (fenofibrate vs. nonuser: HR: 0.84, 95%CI: 0.75-0.94; statins vs nonuser: HR: 0.94, 95%CI: 0.90-0.97) compared with the nonuser group. The fenofibrate group further exhibited the lowest incidence of permanent dialysis (fenofibrate vs. nonuser: SHR: 0.78, 95% CI: 0.77-0.80; statins vs. fenofibrate: SHR: 1.27, 95%CI: 1.26-1.29; combination vs. fenofibrate: SHR: 1.15, 95%CI: 1.13-1.17). Furthermore, the combined administration of fenofibrate and high intensity statins exhibited a lower risk of MACCEs. Conclusions For patients with advanced CKD, continuing fenofibrate may provide a protective effect on CV outcomes equal to that of statins, and it may further delay the need for permanent dialysis. The combination of fenofibrate and high intensity statins may have additional benefits.