Fenofibrate Increases Creatininemia by Increasing Metabolic Production of Creatinine
Abstract
Fenofibrate is a potent hypolipemic agent, widely used in patients with renal insufficiency in whom dyslipidemia is frequent. A moderate reversible increase in creatinine plasma levels is an established side effect of fenofibrate therapy, which mechanism remains unknown. We have previously reported that in 13 patients with normal renal function or moderate renal insufficiency, two weeks of fenofibrate therapy increased creatininemia without any changes in renal plasma flow and glomerular filtration rate [1]. In 13 additional patients, muscular enzymes (AST, GPT, CPK, LDH) and myoglobin were measured before and after 2 weeks on fenofibrate, and the values of creatininemia obtained by the Jaffé technique and HPLC were compared. CPK and AST activity and plasma myoglobin increased in 2 patients with fenofibrate, but muscular enzymes remained unchanged in the population as a whole, and were not correlated to the changes in creatininemia. The changes in creatininemia induced by fenofibrate measured by the Jaffé technique were strongly correlated to those measured by HPLC (r(2) = 0.675, p = 0.0006). Analysis of the pooled data of the two arms of the study showed in 26 patients that two weeks of fenofibrate therapy efficiently reduced total cholesterol and triglycerides plasma levels, and raised creatininemia from 139 +/- 8 to 160 +/- 10 micromol/l (p < 0.0001), but confirmed that creatininuria also increased to the extent that creatinine clearance remained unchanged (68 +/- 6 vs. 67…
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Fibrates cause acute elevation of creatinine.
“the acute elevation of creatinine caused by fibrates (22)”
From Effects of Fibrates in Kidney Disease (2012) · cites this paper as [22]
Hottelart et al. demonstrated increased creatinuria with no fall in creatinine clearance.
“Hottelart et al. demonstrated increased creatinuria with no fall in creatinine clearance [25].”
The two studies had contrasting fenofibrate effects on renal plasma flow but both concluded there was no loss of glomerular function.
“Fenofibrate effects on renal plasma flow in these two studies were also contrasting [16,25], but both concluded there was no loss of glomerular function.”
Previous studies show an initial rise in serum creatinine when starting fibrates that is reversible on cessation of the medication.
“Our findings corroborate previous studies that show an initial rise in serum creatinine when starting fibrates that is reversible on cessation of the medication.12, 13, 21, 22”
From Associations of Fenofibrate Therapy With Incidence and Progression of CKD in Patients With Type 2 Diabetes (2019) · cites this paper as [21]
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“Our findings corroborate previous studies that show an initial rise in serum creatinine when starting fibrates that is reversible on cessation of the medication.(12,13,21,22) In addition, we confirm prior reports that demonstrated the association of fenofibrate use with preservation of kidney function in patients with…”
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- Authors
- Hottelart, C., El Esper, N., Rose, F., Achard, J.-M., & Fournier, A.
- Affiliations
- Centre Hospitalier Universitaire Amiens-Picardie (FR)
- ORCID
- Fournier, Albert
- Venue
- Nephron
- Publisher
- S. Karger AG
- Published
- 2002
- Volume
- 92
- Issue
- 3
- Pages
- 536-541
- ISSN
- 1660-8151 (ISSN-L)
- 2235-3186
- OpenAlex
- W2003602721
- Cited by
- 186
- References
- 2
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 5 · 2023: 4 · 2022: 3 · 2021: 9 · 2020: 9 · 2019: 1 · 2018: 5 · 2017: 9 · 2016: 4 · 2015: 7 · 2014: 11 · 2013: 13 · 2012: 16
- FWCI
- 3.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Nephron journals/Nephron journals (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- fenofibrate, renal failure, creatinine clearance, myoglobin, creatine kinase, drug-induced nephrotoxicity, dyslipidemia, lipid-lowering drugs
- MeSH terms
- Aged, Alanine Transaminase, Hypolipidemic Agents, Aspartate Aminotransferases, Chromatography, High Pressure Liquid, Creatine Kinase, Creatinine, Female, Humans, Hyperlipidemias, L-Lactate Dehydrogenase, Male, Middle Aged, Myoglobin, Fenofibrate, Renal Insufficiency
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