Fenofibrate-associated changes in renal function and relationship to clinical outcomes among individuals with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) experience

被引:52
作者
Bonds, D. E. [1 ]
Craven, T. E. [2 ]
Buse, J. [3 ]
Crouse, J. R. [4 ]
Cuddihy, R. [5 ]
Elam, M. [6 ]
Ginsberg, H. N. [7 ]
Kirchner, K. [8 ]
Marcovina, S. [9 ]
Mychaleckyj, J. C. [10 ]
O'Connor, P. J. [11 ]
Sperl-Hillen, J. -A. [11 ]
机构
[1] NHLBI, Div Cardiovasc Sci, NIH, Rockledge Ctr 2, Bethesda, MD 20892 USA
[2] Wake Forest Sch Med, Dept Biostat Sci, Div Publ Hlth Sci, Winston Salem, NC USA
[3] Univ N Carolina, Sch Med, Dept Med, Chapel Hill, NC USA
[4] Wake Forest Sch Med, Dept Med, Winston Salem, NC USA
[5] Int Diabet Ctr, Minneapolis, MN USA
[6] Vet Affairs Med Ctr, Memphis, TN USA
[7] Columbia Univ Coll Phys & Surg, Dept Med, New York, NY 10032 USA
[8] Montgomery Vet Adm Med Ctr, Jackson, MS USA
[9] Univ Washington, NW Lipid Metab & Diabet Res Lab, Seattle, WA 98195 USA
[10] Univ Virginia, Dept Publ Hlth Sci, Charlottesville, VA USA
[11] HealthPartners Res Fdn, Minneapolis, MN USA
关键词
Cardiovascular; Creatinine; Fenofibrate; Outcomes; Renal; PROLIFERATOR-ACTIVATED RECEPTORS; FIBRATE-INDUCED INCREASE; BLOOD UREA; CREATININE; ROSIGLITAZONE; COMBINATION; PROGRESSION; EQUATION; THERAPY; DISEASE;
D O I
10.1007/s00125-012-2524-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Fenofibrate has been noted to cause an elevation in serum creatinine in some individuals. Participants in the Action to Control Cardiovascular Risk in Diabetes Lipid Study were studied to better characterise who is at risk of an increase in creatinine level and to determine whether those with creatinine elevation have a differential risk of adverse renal or cardiovascular outcomes. A fenofibrate-associated creatinine increase (FACI) was defined as an increase in serum creatinine of at least 20% from baseline to month 4 in participants assigned to fenofibrate. Baseline patient characteristics, and baseline and 4-month drug, clinical, laboratory characteristics and study outcomes were examined by FACI status. Of the sample, 48% of those randomised to receive fenofibrate had at least a 20% increase in serum creatinine within 4 months. In multivariable analysis, participants who were older, male, used an ACE inhibitor at baseline, used a thiazolidinedione (TZD) at 4 months post-randomisation, had baseline CVD, and had lower baseline serum creatinine and LDL-cholesterol levels were all more likely to meet the criteria for FACI. Participants in the FACI group were also more likely to have a decrease in their serum triacylglycerol level from baseline to 4 months. No differences in study outcomes were seen by FACI criteria. Several characteristics predict a rapid rise in serum creatinine upon starting fenofibrate. Participants who met the criteria for FACI also had a greater change in triacylglycerol levels. In the setting of careful renal function surveillance and reduction of fenofibrate dose as indicated, no increase in renal disease or cardiovascular outcome was seen in those individuals demonstrating FACI.s.
引用
收藏
页码:1641 / 1650
页数:10
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