Effects of Long-Term Fenofibrate Treatment on Markers of Renal Function in Type 2 Diabetes
Open accessAbstract
OBJECTIVE: Although fenofibrate was associated with less progression of albuminuria in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, it is unknown if it has any effect on renal function. We explored if there were changes in commonly available markers of renal function during fenofibrate treatment in the FIELD Helsinki cohort excluding statin users. RESEARCH DESIGN AND METHODS: One hundred and seventy subjects with type 2 diabetes were randomly assigned to micronized fenofibrate (200 mg/day) or placebo for 5 years. In this substudy, we measured several markers of albumin excretion and renal function. RESULTS: After intensified treatment, blood pressure and fasting glucose decreased in both groups while A1C remained at 7.2%. Plasma creatinine increased with fenofibrate while urine creatinine remained comparable between the groups, resulting in significant decreases in both creatinine clearance and estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease (MDRD)-4 and Cockroft-Gault equations in the fenofibrate group. Cystatin C increased during fenofibrate treatment. Urinary albumin-to-creatinine ratio and diurnal urine protein remained unchanged, whereas overnight urinary albumin excretion rate showed minor decreases in both groups. CONCLUSIONS: We report concomitant decreases in creatinine clearance and eGFR by fenofibrate. These changes complicate the clinical surveillance during fenofibrate treatment. We could not demonstrate the beneficial effects of fenofibrate on albumin excretion. A novel finding is the increase of cystatin C in type 2 diabetic patients during fenofibrate treatment. The clinical relevance of the changes needs to be assessed in a long-term outcome study of renal function.
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The Helsinki sub-study had no washout phase and was therefore not able to unmask the underlying GFR preservation demonstrated now by us.
“However, the study had no washout phase and was therefore not able to unmask the underlying GFR preservation demonstrated now by us.”
The Helsinki sub-study found a greater fall in estimated GFR in patients allocated fenofibrate compared with placebo, in keeping with our on-study findings.
“They also found a greater fall in estimated GFR in patients allocated fenofibrate compared with placebo, in keeping with our on-study findings.”
The initial plasma creatinine rise associated with fenofibrate appears to be partly due to a decrease in creatinine clearance without reduced inulin-derived GFR.
“The rise appears to be partly due to a decrease in creatinine clearance [16,21] without reduced inulinderived GFR [16,24]”
A very similar rise in serum cystatin C was demonstrated in the Helsinki sub-study.
“A very similar rise in serum cystatin C was also demonstrated in the Helsinki sub-study [21], but measurements were not repeated after treatment withdrawal.”
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- Authors
- Forsblom, C., Hiukka, A., Leinonen, E. S., Sundvall, J., Groop, P.-H., & Taskinen, M.-R.
- Affiliations
- Helsinki University Hospital (FI)
- Finnish Institute for Health and Welfare (FI)
- Corresponding author
- Taskinen, Marja-Riitta
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2009-10-21
- Volume
- 33
- Issue
- 2
- Pages
- 215-220
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2809252
- OpenAlex
- W2128536064
- Cited by
- 81
- References
- 15
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 3 · 2018: 2 · 2017: 5 · 2016: 6 · 2015: 5 · 2014: 5 · 2013: 6 · 2012: 13
- FWCI
- 7.83
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Helsingin ja Uudenmaan Sairaanhoitopiiri
- Aarne Koskelon Säätiö
- Diabetesliitto
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- fenofibrate, type 2 diabetes, renal function, estimated glomerular filtration rate, creatinine clearance, cystatin C, albuminuria, albumin excretion, fieldwork, lipid-lowering therapy, drug safety
- MeSH terms
- Aged, Albuminuria, Hypolipidemic Agents, Blood Glucose, Blood Pressure, Creatinine, Diabetes Mellitus, Type 2, Female, Glomerular Filtration Rate, Humans, Kidney, Kidney Function Tests, Male, Middle Aged, Placebos, Fenofibrate, Prognosis, Triglycerides
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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