Fibrates and the risk of cardiovascular outcomes in chronic kidney disease patients
Open accessAbstract
Background: The high risk of major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD) has been well described. However, the efficacy of fibrates on the risk of MACE in patients with CKD remains unclear. Methods: We conducted a nested case–control study using data from a large administrative database that included more than 1.5 million Japanese patients. We defined cases as CKD patients with incidences of MACE and matched them with controls based on age, sex, calendar year of cohort entry and CKD stage. Fibrate exposure timing was categorized as current, recent or past. A conditional logistic regression analysis was used to investigate the association between fibrate use and the risk of MACE. Results: Our study included 47 490 patients with CKD, with 15 830 MACE identified during a median follow-up of 9.4 months. The numbers of fibrates used during the study period were 556 (3.5%) in the case group and 1109 (3.5%) in the control group. Fibrate use was significantly associated with a decreased risk of MACE [odds ratio (OR) 0.84; 95% confidence interval (CI) 0.75–0.94], particularly for current (OR 0.81; 95% CI 0.68–0.97) and recent use (OR 0.65; 95% CI 0.48–0.90). Regarding the class effect of fibrates, pemafibrate use, but not bezafibrate or fenofibrate use, was significantly associated with a decreased risk of MACE (OR 0.73; 95% CI 0.528–0.997). Conclusion: Recent and current fibrate use, especially pemafibrate use, was associated with a reduced risk of MACE in patients with CKD. This suggests the potential benefits of continuous fibrate therapy and the possible superiority of pemafibrate over other fibrates. However, further investigations in different populations are required to confirm the generalizability of these findings.
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Fibrates may confer cardiovascular protection beyond their effects on lipids in patients with chronic kidney disease, as suggested by observational studies including a nested case-control analysis of pemafibrate use.
“Patients with chronic kidney disease represent a high-risk population in whom hypertriglyceridemia is common, and fibrates may confer cardiovascular protection beyond their effects on lipids, as suggested by observational studies including a nested case–control analysis of pemafibrate use [83].”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [83]
The Introduction (page unavailable) describes patients with CKD as at high cardiovascular risk. The Discussion (page unavailable) reports a nested case–control association between current pemafibrate use and lower MACE risk and suggests that anti-inflammatory effects may contribute alongside lipid effects. The passages do not establish that hypertriglyceridemia is common in CKD or demonstrate protection independent of lipid effects. (LLM, conf=0.82)
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References 22 · Cited by 24
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- Authors
- Goto, H., Iseri, K., & Hida, N.
- Affiliations
- SHOWA Medical University (JP)
- Corresponding author
- Goto, Hirohito
- Venue
- Nephrology Dialysis Transplantation
- Publisher
- Oxford University Press (OUP)
- Published
- 2023-11-27
- Volume
- 39
- Issue
- 6
- Pages
- 1016-1022
- ISSN
- 0931-0509 (ISSN-L)
- 1460-2385
- PMC
- PMC11139516
- OpenAlex
- W4389099101
- Cited by
- 24
- References
- 22
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 5
- FWCI
- 4.66
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Nephrology Dialysis Transplantation (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Keywords
- fibrates, chronic kidney disease, major adverse cardiovascular events, pemafibrate, bezafibrate, fenofibrate, cardiovascular risk reduction, lipid-lowering therapy, Japanese patients
- MeSH terms
- Aged, Hypolipidemic Agents, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Japan, Male, Middle Aged, Prognosis, Risk Factors, Case-Control Studies, Renal Insufficiency, Chronic, Fibric Acids
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