Factors Associated With Fibrate-Induced Creatinine Elevation: Observations in an Outpatient Setting

Аббас,

doi:10.4021/wjnu27w

Cited by 2 publications

(4 citation statements)

References 32 publications

(45 reference statements)

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“…Significant changes were seen in TC, TG and HDL-C following fibrate treatment. These findings were anticipated as our patient group was a subset of the cohort previously reported regards the above analytes (Ramachandran et al, 2012 ; Abbas et al, 2012 ). All three LFT studied decreased (Table 1 ) with fibrate treatment with paired t -Test showing the changes to be significant; GGT (p < 0.0001), ALT (p = 0.0014) and ALP (p < 0.0001).…”

Section: Resultsmentioning

confidence: 65%

Effect of fibrate treatment on liver function tests in patients with the metabolic syndrome

et al. 2014

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BackgroundFibrates are used especially in patients with hypertriglyceridaemia, a feature of the metabolic syndrome. Elevated LFTs are often observed in these patients perhaps related to fatty infiltration.AimWe wished to study changes seen in LFTs (GGT, ALT and ALP) following fibrate therapy and then determine associated factors.MethodsThis was a retrospective observational study in which data was collected from case notes of patients started on fibrates (n = 118, 2002–2008) in the lipid clinic at Good Hope Hospital and pre/post-fibrate lipid and LFT values were obtained. All biochemistry was performed on the Roche P-Unit using supplied reagents. Statistical analyses included t tests and regression analyses (factorised when quartiles were compared).ResultsOf the study population 106 patients were on fenofibrate; the remaining on bezafibrate. Significant lowering of GGT (p < 0.0001), ALT (p = 0.0014) and ALP (p < 0.0001) levels were observed following fibrate treatment. Baseline lipid (cholesterol, triglycerides and HDL) concentrations, alcohol intake, length of treatment, gender, concurrent statin treatment and diabetes did not correlate with these changes in LFT in a multiple regression analysis. Higher pre-fibrate GGT (p < 0.0001), ALT (p < 0.0001) and ALP (p < 0.0001) concentrations were associated with larger decreases in each of these tests respectively with the highest 2 quartiles (GGT > 57 IU/l, ALT > 34 IU/l and ALP > 94 IU/l) significantly different to the lowest quartile. The above associations remained significant even when the regression analyses were corrected for changes in lipid values (which did not show an association).ConclusionsFibrate treatment led to improvements in LFT, the greatest benefit seen in patients with higher baseline LFT values. It appears that baseline and changes in lipid values post fibrate treatment were not associated with change in LFT.

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Section: Resultsmentioning

confidence: 65%

Effect of fibrate treatment on liver function tests in patients with the metabolic syndrome

et al. 2014

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“…In the study by Abbas et al [1] the use of a Jaffe creatinine assay presents a potential problem, since, unlike the enzymatic method used in our study, this method is prone to a range of analytical interferences. The findings, however, are still of interest.…”

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confidence: 91%

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Fenofibrate-Associated Creatinine Increase: A Case for More Prospective Studies

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2012

World J Nephrol Urol

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We read with interest a recently published study by Abbas et al in which the authors discussed the factors associated with the well-established rise in creatinine associated with fibrate treatment. They retrospectively analysed the case notes from a lipid clinic database of 132 patients [1].In accord with a number of studies published in the last 13 years (Tsimihodimos et al [2], Hottelart et al [3], Ansquer et al [4] ), interalia, the authors have shown a fibrate-associated increase in creatinine. In a recent prospective study, in hyperlipidaemic patients attending a lipid clinic [5] we have demonstrated a similar rise in serum creatinine using a Siemens enzymatic creatinine assay (Siemens Healthcare Diagnostics, Frimley, UK), which is traceable to isotope dilution/ mass spectrometry (ID/MS). This rise in creatinine (median 15.1%; range 5.5-23.2 %) was accompanied by an increase in cystatin C (median 9.9%; range 1.1-26.1%) in 10 of the 12 patients studied.We concluded that since the increase in serum creatinine concentration was accompanied by a rise in cystatin C, an independent marker of GFR, the fibrate-related creatinine increase reflects a genuine reduction in renal function rather than an increased metabolic production of creatinine as previously proposed by Hottelart et al [3]. It is unlikely that another mechanism is responsible since it would need to affect both creatinine and cystatin C in a similar manner. Although our study was limited to only 12 patients, our findings reflect those of larger studies, for example, a substudy of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial [6].Recently, Mychaleckj et al [7] have shown a reversal of the fibrate-induced rise in cystatin C concentration on stopping fibrate treatment, which further suggests that fibrateinduced renal hypofunction occurs.In the study by Abbas et al [1] the use of a Jaffe creatinine assay presents a potential problem, since, unlike the enzymatic method used in our study, this method is prone to a range of analytical interferences. The findings, however, are still of interest. Although the dose of fenofibrate used was not stated, (and was probably variable), the authors have interestingly, corrected their data for the duration of treatment.We speculate that some of the differences seen between studies may be related to fenofibrate dose in addition to the duration of therapy. There is a need for more prospective studies investigating the mechanism(s) and clinical significance of a fibrate-associated creatinine increase. The measurement of GFR using more accurate methods such as Inulin or para amino hippurate (PAH) clearance do not lend themselves to routine clinical use, but may currently offer the best prospect for gaining a clearer insight into this interesting phenomenon. References1. Abbas A, Sarafa S, Ramachandran S, Raju J, Ramachandran S. Factors Associated With Fibrate-Induced Creatinine Elevation: Observations in an Outpatients Setting. World J Nephrol Urol. 2012; 1(2-3):51-58 2. Tsimihodimos V, Kakafika A...

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Factors Associated With Fibrate-Induced Creatinine Elevation: Observations in an Outpatient Setting

Cited by 2 publications

References 32 publications

Effect of fibrate treatment on liver function tests in patients with the metabolic syndrome

Effect of fibrate treatment on liver function tests in patients with the metabolic syndrome

Fenofibrate-Associated Creatinine Increase: A Case for More Prospective Studies

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