Fenofibrate and renal disease: clinical effects in diabetes

Fenofibrate is known to increase serum creatinine, but this effect is fully reversible, even after long-term treatment. The mechanism underlying this is poorly understood, but fenofibrate is not thought to impair true glomerular function, as measured by inulin clearance, the gold standard measure of renal function. This iatrogenic creatinine rise does not increase the risk of adverse renal outcomes or cardiovascular events. In two large randomized controlled trials of patients with Type 2 diabetes, fenofibrate was shown to be able to reduce albuminuria and slow the rate of calculated glomerular filtration rate (GFR) loss. This beneficial effect of fenofibrate on estimated GFR is only unmasked when the artificial reduction in calculated GFR is removed on drug cessation. Interestingly, in one of the trials, patients with the greatest fenofibrate-associated creatinine rise appeared to derive the greatest cardiovascular benefit.