People with type 2 diabetes and moderate renal impairment are at particular risk of cardiovascular disease (CVD). Although the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study has already demonstrated the beneficial effects of fenofibrate on cardiovascular risk, current guidelines recommend a dose reduction in people with even mild renal impairment due to a rise in plasma creatinine which may adversely affect CVD risk and renal outcomes.
This study investigated the effects of standard dose fenofibrate (200 mg daily) or placebo over a 5-year period in people with type 2 diabetes grouped according to estimated glomerular filtration rate (eGFR, i.e. 30−59, 60−89 and ≥90 mL/min/1.73m2). The pre-specified outcome was total cardiovascular events, and in addition serious adverse events and instances of end stage renal disease (ESRD) were also recorded.
The study found no evidence that the use of standard dose fenofibrate in people with type 2 diabetes and moderate renal impairment had any adverse effects on either CVD or renal outcomes, with the greatest absolute reduction of 49% for CVD events observed in people with an eGFR of 30−59 mL/min/1.73m2. No excess ESRD events were observed in people treated with fenofibrate in any GFR group.
The authors commented that these study findings should allay any previous concerns around contraindicating the use of fenofibrate in people with moderately poor renal function or in those who experience an initial increase in plasma creatinine with fenofibrate, and indeed, current guidelines may be too restrictive.
Reference
Ting RD et al (2012) Benefits and safety of long-term fenofibrate therapy in people with type 2 diabetes and renal impairment: The FIELD study. Diabetes Care 35: 218−25
