Fenofibrate reduces progression to microalbuminuria over 3 years in a placebo-controlled study in type 2 diabetes: Results from the Diabetes Atherosclerosis Intervention Study (DAIS)
Abstract
Background Microalbuminuria is an early marker of diabetic nephropathy and an independent risk factor for cardiovascular disease. In the Diabetes Atherosclerosis Intervention Study (DAIS), treatment of people with type 2 diabetes with micronized fenofibrate for an average of 38 months reduced the progression of angiographically evaluated coronary artery disease and improved lipoprotein level abnormalities compared with placebo. The aim of this analysis is to study the influence of the treatment on changes in urinary albumin excretion. Methods Microalbuminuria was measured on 2 to 3 occasions by using timed overnight samples at baseline and yearly thereafter in 314 DAIS participants (77 women, 237 men; average age, 56 years); all except 3 participants had either a normal albumin excretion rate ( Results Fenofibrate significantly reduced the worsening of albumin excretion (fenofibrate, 8% versus placebo, 18%; P Conclusion Improvement in lipid profiles with fenofibrate in patients with type 2 diabetes was associated with reduced progression from normal albumin excretion to microalbuminuria.
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Initial changes in serum creatinine and estimated GFR with fibrates do not affect actual kidney function.
“Although these initial changes in creatinine levels and estimated GFR are true, newer data from well-designed randomised controlled trials (RCTs) show that these changes do not affect the actual kidney function [6,7,8].”
From The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis of Randomised Studies (2022) · cites this paper as [8]
The FIELD, ACCORD and DAIS trials showed a beneficial effect of fibrates on albuminuria in diabetic patients.
“In fact, the FIELD [6], the ACCORD [7] and the DAIS [8] trials showed a beneficial effect of fibrates on albuminuria in diabetic patients; an established marker of early microvascular disease and a predictor of adverse CVD outcomes and kidney disease progression.”
From The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis of Randomised Studies (2022) · cites this paper as [8]
Overall, 4 trials had a Jadad score of 4, 1 scored 3, 2 scored 2, and 1 scored 1.
“Overall, 4 trials had a Jadad score of 4 (24,25,32,35), 1 scored 3 (33), 2 scored 2 (29,31), and 1 scored 1 (30).”
From Effects of Fibrates in Kidney Disease (2012) · cites this paper as [33]
Fenofibrate has been shown to decrease albuminuria in a mouse model of type 2 diabetes and in humans.
“Fenofibrate has been shown to decrease albuminuria in a mouse model of type 2 diabetes [10] and in humans [1,2,11].”
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References 22 · Cited by 264
- Authors
- Ansquer, J.-C., Foucher, C., Rattier, S., Taskinen, M.-R., & Steiner, G.
- Affiliations
- Helsinki University Hospital (FI)
- Toronto General Hospital (CA)
- Corresponding author
- Ansquer, Jean-Claude
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2005-03
- Volume
- 45
- Issue
- 3
- Pages
- 485-493
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W1971213885
- Cited by
- 264
- References
- 22
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 6 · 2023: 9 · 2022: 10 · 2021: 7 · 2020: 8 · 2019: 3 · 2018: 9 · 2017: 6 · 2016: 8 · 2015: 9 · 2014: 14 · 2013: 15 · 2012: 21
- FWCI
- 15.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- fenofibrate, microalbuminuria, type 2 diabetes, diabetic nephropathy, albumin excretion, macroalbuminuria, lipid-lowering therapy, cardiovascular risk
- MeSH terms
- Albuminuria, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Hypolipidemic Agents, Blood Pressure, Creatinine, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Double-Blind Method, Female, Fibrinogen, Follow-Up Studies, Glycated Hemoglobin, Homocysteine, Humans, Hyperlipidemias, Hypertension, Male, Middle Aged, Models, Biological, Fenofibrate, Smoking, Body Mass Index, Incidence, Treatment Outcome, Disease Progression, Angiotensin II Type 1 Receptor Blockers
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