Use of fibrates is not associated with reduced risks of mortality or cardiovascular events among ESRD patients: A national cohort study

Abstract

BackgroundAlthough a recent study reported that fibrates are associated with a low risk of cardiovascular (CV) death and can postpone the need for long-term hemodialysis in patients with advanced chronic kidney disease (CKD), little is known regarding whether the CV protective effects of fibrates extend to patients with end-stage renal disease (ESRD). The present study compared CV outcomes and mortality among patients with ESRD treated with fibrates, statins, neither, or their combination.MethodsThis cohort study extracted data from Taiwan's National Health Insurance Research Database (NHIRD). Adult patients with ESRD and hyperlipidemia were identified and categorized into four groups (fibrate, statin, combination, and non-user groups) according to their use of different lipid-lowering therapies within 3 months prior to the commencement of permanent dialysis. Inverse probability of treatment weighting was used to balance the baseline characteristics of the groups. The follow-up outcomes were all-cause mortality, CV death, and major adverse cardiac and cerebrovascular events (MACCEs).ResultsCompared with the non-user and statin groups, the fibrate group did not exhibit significantly lower risks of all-cause mortality [fibrate vs. non-user: hazard ratio (HR), 0.97; 95% confidence interval (CI), 0.92–1.03; statin vs. fibrate: HR, 0.95; 95% CI, 0.90–1.01], CV death (fibrate vs. non-user: HR, 0.97; 95% CI, 0.90–1.05; statin vs. fibrate: HR, 0.97; 95% CI, 0.90–1.06), and MACCEs (fibrate vs. non-user: HR, 1.03; 95% CI, 0.96–1.10; statin vs. fibrate: HR, 0.94; 95% CI, 0.87–1.004). The combination of fibrates and statins (specifically moderate- to high-potency statins) did not result in lower risks of all-cause mortality, CV death, or MACCEs compared with statins alone.ConclusionIn patients with ESRD, the use of fibrates might be not associated with reduced mortality or CV risks, regardless of whether they are used alone or in combination with statins.

Effect of sacubitril/valsartan on lipid metabolism in patients with chronic kidney disease combined with chronic heart failure: a retrospective study

“…Messow et al’s meta-analysis, which incorporated 13 studies examining statin-treated CKD, revealed an escalation in cardiovascular risk with the progression of CKD stages [ 23 ]. Ho et al’s cohort study found that fibrates may not effectively reduce cardiovascular risk [ 24 ]. This study focused on elucidating the influence of sacubitril/valsartan on lipid metabolism in individuals with CKD and CVD, intending to offer insights for future research.…”

Associations of Long-term PM10 Exposure with Mortality in Dialysis Patients: A Population Based Cohort Study

“…In Taiwan, the primary reason for withdrawal from the NHI program is death, especially for individuals with catrostrophic illness whose high medical expenditures were nearly fully covered by NHI (Wu et al, 2012). Less common reasons include permanent emigration, being missing for more than 6 months, or being incarcerated for more than 6 months (Chung et al, 2022;Ho et al, 2022).…”

Fibrates and the risk of cardiovascular outcomes in chronic kidney disease patients

“…A population-based study in Taiwan showed that fibrates reduced the risk of cardiovascular events and delayed dialysis initiation [ 11 ]. However, the data are limited and inconsistent in the CKD population [ 12 ]. Fibrate use is poorly studied in the Japanese population, especially in patients with CKD, as its use was limited in the past because of the contraindication for combined use with statins.…”