The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis of Randomised Studies
Aim: Fibrates have proven efficacy in cardiovascular risk reduction and are commonly used, in addition to statins, to control hypertriglyceridaemia. Their use is often limited due to reduction in glomerular filtration rate at treatment initiation. However, recent studies suggest benign changes in ki...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/3/768 |
| _version_ | 1797486916201873408 |
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| author | Alexandros Hadjivasilis Panayiotis Kouis Andreas Kousios Andrie Panayiotou |
| author_facet | Alexandros Hadjivasilis Panayiotis Kouis Andreas Kousios Andrie Panayiotou |
| author_sort | Alexandros Hadjivasilis |
| collection | DOAJ |
| description | Aim: Fibrates have proven efficacy in cardiovascular risk reduction and are commonly used, in addition to statins, to control hypertriglyceridaemia. Their use is often limited due to reduction in glomerular filtration rate at treatment initiation. However, recent studies suggest benign changes in kidney function and improvement of proteinuria, an established early marker of microvascular disease and kidney disease progression. We summarize the evidence from existing trials and provide a summary of effects of fibrates, alone or in combination, on kidney disease progression and proteinuria. Methods and Results: Systematic review and meta-analysis of randomized, controlled trials (PROSPERO CRD42020187764). Out of 12,243 potentially eligible studies, 29 were included in qualitative and quantitative analysis, with a total of 20,176 patients. Mean creatinine increased by 1.05 (95% CI (0.63 to 1.46)) units in patients receiving fibrates vs. comparator, and this was similar in all other subgroups. eGFR showed a bigger decrease in the fibrates arm (SMD −1.99; 95% CI (−3.49 to −0.48)) when all studies were pooled together. Notably, short-term serum creatinine and eGFR changes remained constant in the long-term. Pooled estimates show that fibrates improve albuminuria progression, RR 0.86; 95% CI (0.76 to 0.98); albuminuria regression, RR 1.19; 95% CI (1.08 to 1.310). Conclusions: Fibrates improve albuminuria in patients with and without diabetes when used to treat hyperlipidaemia. The modest creatinine increase should not be a limiting factor for fibrate initiation in people with preserved renal function or mild CKD. The long-term effects on kidney disease progression warrant further study. |
| first_indexed | 2024-03-09T23:40:09Z |
| format | Article |
| id | doaj.art-a887b0ef1d824f65bb86af7b8dd1cbcd |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T23:40:09Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-a887b0ef1d824f65bb86af7b8dd1cbcd2023-11-23T16:53:42ZengMDPI AGJournal of Clinical Medicine2077-03832022-01-0111376810.3390/jcm11030768The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis of Randomised StudiesAlexandros Hadjivasilis0Panayiotis Kouis1Andreas Kousios2Andrie Panayiotou3Cardiovascular Epidemiology and Genetics Research Lab, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3036, CyprusCardiovascular Epidemiology and Genetics Research Lab, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3036, CyprusCardiovascular Epidemiology and Genetics Research Lab, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3036, CyprusCardiovascular Epidemiology and Genetics Research Lab, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3036, CyprusAim: Fibrates have proven efficacy in cardiovascular risk reduction and are commonly used, in addition to statins, to control hypertriglyceridaemia. Their use is often limited due to reduction in glomerular filtration rate at treatment initiation. However, recent studies suggest benign changes in kidney function and improvement of proteinuria, an established early marker of microvascular disease and kidney disease progression. We summarize the evidence from existing trials and provide a summary of effects of fibrates, alone or in combination, on kidney disease progression and proteinuria. Methods and Results: Systematic review and meta-analysis of randomized, controlled trials (PROSPERO CRD42020187764). Out of 12,243 potentially eligible studies, 29 were included in qualitative and quantitative analysis, with a total of 20,176 patients. Mean creatinine increased by 1.05 (95% CI (0.63 to 1.46)) units in patients receiving fibrates vs. comparator, and this was similar in all other subgroups. eGFR showed a bigger decrease in the fibrates arm (SMD −1.99; 95% CI (−3.49 to −0.48)) when all studies were pooled together. Notably, short-term serum creatinine and eGFR changes remained constant in the long-term. Pooled estimates show that fibrates improve albuminuria progression, RR 0.86; 95% CI (0.76 to 0.98); albuminuria regression, RR 1.19; 95% CI (1.08 to 1.310). Conclusions: Fibrates improve albuminuria in patients with and without diabetes when used to treat hyperlipidaemia. The modest creatinine increase should not be a limiting factor for fibrate initiation in people with preserved renal function or mild CKD. The long-term effects on kidney disease progression warrant further study.https://www.mdpi.com/2077-0383/11/3/768cardivacular diseaserenal functionproteinuriafibrates |
| spellingShingle | Alexandros Hadjivasilis Panayiotis Kouis Andreas Kousios Andrie Panayiotou The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis of Randomised Studies Journal of Clinical Medicine cardivacular disease renal function proteinuria fibrates |
| title | The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis of Randomised Studies |
| title_full | The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis of Randomised Studies |
| title_fullStr | The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis of Randomised Studies |
| title_full_unstemmed | The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis of Randomised Studies |
| title_short | The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis of Randomised Studies |
| title_sort | effect of fibrates on kidney function and chronic kidney disease progression a systematic review and meta analysis of randomised studies |
| topic | cardivacular disease renal function proteinuria fibrates |
| url | https://www.mdpi.com/2077-0383/11/3/768 |
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