Effects of Fenofibrate on Kidney Function: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XU Chuan , YUAN Zijing ,  ZHU Jiang

Department of Nephrology, Nanjing Jiangning Hospital, Nanjing 211110, China;

Corresponding author：

ZHU Jiang, Email: jnyysnk@163.com

Keywords：

Fenofibrate; Uric acid; Systematic review; Meta-analysis; Randomized controlled trial; Quasi-randomized controlled trial

DOI：

10.7507/1672-2531.20130233

Video：

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Objective 　To systematically review the effects of fenofibrate on kidney function in various populations, so as to provide references for selecting the methods of treating hyperuricemia.
Methods 　Such databases as PubMed (1966-2013), EMbase (1984-2013), The Cochrane Library (Issue 1, 2012), CBM (1978-2013), and CNKI (1989-2013) were electronically searched for relevant randomized controlled trials or non-randomized controlled trials on fenofibrate for treating hyperuricemia. According to the Cochrane methods, two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.0 software.
Results 　A total of 16 studies involving 346 patients were included in total. The results of meta-analysis showed that: a) compared with the control group, the fenofibrate group had the lower serum uric acid level (WMD=48.68, 95%CI 10.02 to 87.34, P lt;0.000 01), lower Ccr (endogenous creatinine clearance) level (WMD=8.88, 95%CI 1.29 to 16.47, P=0.002), and similar serum creatinine level (WMD=1.78, 95%CI –2.86 to 6.42, P=0.45); and b) adverse reaction included gastrointestinal discomforts, skin rashes and transient increase of GPT and transaminase, most of which were mild.
Conclusion 　Fenofibrate has good effects. Due to the low quality of the included studies, the exact effectiveness and adverse reaction need to be rigorously verified based on more multi-center, double-blind, randomized controlled trials with large sample size.

Citation： XU Chuan,YUAN Zijing,ZHU Jiang. Effects of Fenofibrate on Kidney Function: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(11): 1361-1366. doi: 10.7507/1672-2531.20130233 Copy

1.	The FIELD study investigators. Effect of long term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet, 2005, 366(9500): 1849.
2.	Bastow MD, Durrington PN, Ishola M. Hypertriglyceridemia and hyperuricemia: effects of two fibric acid derivatives (bezafibrate and fenofibrate) in a double-blind, placebo-controlled trial. Metabolism, 1988, 37(3): 217-220.
3.	Obermayr RP, Temml C, Gutjahr G, et al. Elevated uric acid increases the risk for kidney disease. J Am Soc Nephrol, 2008, 19(12): 2251-2253.
4.	Liamis G, Bairaktari ET, Eliasf M. Effect of fenofibrate on serum uric acid levels. Am J Kidney Dis, 1999, 34: 594.
5.	YamamokT, MoriwakiY, Takahashi S, et al. Effect offenofibrate on plasma concentration and urinary excretion of purine bases and oxyPurinol. Eur J ClinInvest, 2000, 30(10): 871-878.
6.	王慧华, 李开沪, 朱秀英. 微粒化非诺贝特与苯扎贝特治疗老年高脂血症和高尿酸血症的比较. 老年医学与保健, 1999, 5(2): 73-75.
7.	Elisaf M, Tsimichodimos V, Bairaktari E, et al. Effect of Micronized Fenofibrate and Losartan Combination on Uric Acid Metabolism in Hypertensive Patients with Hyperuricemia. Journal of Cardiovascular Pharmacology, 1999, 34(1): 60-63.
8.	张文姚, 任爱华, 蒋益忠. 自身交叉试验比较非诺贝特与辛伐他汀降脂疗效及对ApoA、ApoB的影响. 心血管康复医学杂志, 2000, 9(2): 35-37.
9.	王守俊, 刘瑞芳, 魏巧兰. 非诺贝特对糖尿病肾病的前瞻性研究. 辽宁实用糖尿病杂志, 2001, 9(3): 27-28.
10.	Giral P, Bruckert E, Jacob N, et al. Homocysteine and lipid lowering agents. A comparison between atorvastatin and fenobrate in patients with mixed hyperlipidemia. Atherosclerosis, 2001, 154(2): 421-427.
11.	Insua A, Massari F, Moncalvo JJR, et al. Fenofibrate of gemfibrozil for treatment of types IIa and IIb primary hyperlipoproteinemia: a randomized, double-blind, crossover study. Endocr Pract, 2002, 8(2): 96-101.
12.	秦利, 殷峻, 邢惠莉. 非诺贝特缓释微丸对糖尿病患者糖脂代谢紊乱的影响. 上海第二医科大学学报, 2003, 23(3): 261-263.
13.	Milionis HJ, Papakostas J, Kakafika A, et al. Comparative effects of atorvastatin, simvastatin, and fenofibrate on serum homocysteine levels in patients with primary hyperlipidemia. J Clin Pharmacol, 2003, 43(8): 825-830.
14.	孙学春. 微粒化非诺贝特对老年人血脂代谢紊乱的疗效观察. 四川医学, 2005, 26(9): 975-976.
15.	Filippatos TD, Kiortsis DN, Liberopoulos EN, et al. Effect of orlistat, micronised fenofibrate and their combination on metabolic parameters in overweight and obese patients with the metabolic syndrome: the FenOrli study. Curr Med Res Opin, 2005, 21(12): 1997-2006.
16.	刘玉庆, 史淑琴, 赵勇. 逐酸活血汤治疗原发性高尿酸血症并高三酰甘油血症30例的疗效观察. 中国实用医药, 2008, 3(34): 60-62.
17.	Ansquer JC, Dalton RN, Caussé E, et al. Effect of fenofibrate on kidney function: a 6-week randomized crossover trial in healthy people. Am J Kidney Dis, 2008, 51(6): 904-913.
18.	王一扬, 王亦凡, 高振英. 非诺贝特治疗高甘油三酯症和高尿酸症的疗效. 药学与临床, 2009, 12(12): 1787-1789.
19.	刘茜. 非诺贝特和普伐他汀调节血脂及尿酸的研究. 中华全科医学, 2010, 8(1): 60-62.
20.	王大鹏, 高燕燕. 非诺贝特和苯溴马隆治疗高尿酸血症的效果. 齐鲁医学杂志, 2010, 25(6): 524-527.
21.	Goto M. A comparative study of anti-inflammatory and antidyslipidemic effects of fenofibrate and statins on rheumatoid arthritis. Mod Rheumatol, 2010, 20(3): 238-243.
22.	Filippatos TD, Kiortsis DN, Liberopoulos EN, et al. Effect of orlistat, micronised fenofibrate and their combination on metabolic parameters in overweight and obese patients with the metabolic syndrome: the FenOrli study. Curr Med Res Opin, 2005, 21(12): 1997-2006.
23.	Milionis HJ, Elisaf MS. Management of hypertension and dyslipidaemia in patients presenting with hyperuricaemia: case histories. Curr Med Res Opin, 2000, 16(3): 164-170.
24.	Daskalopoulou SS, Tzovaras V, Mikhailidis DP, et al. Effect on serum uric acid levels of drugs prescribed for indications other than treating hyperuricaemia. Curr Pharm Des, 2005, 11(32): 4161-4175.
25.	Lipscombe J, Bargman JM. Fibrate-induced increase in blood urea and creatinine. Nephrol Dial Transplant, 2001, 16(7): 1515.
26.	Davis TME, Ting R, Best JD, et al. Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study. Diabetologia, 2011, 54(2): 280–290.
27.	Katsiki N, Papanas N, Fonseca VA, et al. Uric acid and diabetes: is there a link? Curr Pharm Des, 2013, 19(27): 4930-4937.

1. The FIELD study investigators. Effect of long term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet, 2005, 366(9500): 1849.
2. Bastow MD, Durrington PN, Ishola M. Hypertriglyceridemia and hyperuricemia: effects of two fibric acid derivatives (bezafibrate and fenofibrate) in a double-blind, placebo-controlled trial. Metabolism, 1988, 37(3): 217-220.
3. Obermayr RP, Temml C, Gutjahr G, et al. Elevated uric acid increases the risk for kidney disease. J Am Soc Nephrol, 2008, 19(12): 2251-2253.
4. Liamis G, Bairaktari ET, Eliasf M. Effect of fenofibrate on serum uric acid levels. Am J Kidney Dis, 1999, 34: 594.
5. YamamokT, MoriwakiY, Takahashi S, et al. Effect offenofibrate on plasma concentration and urinary excretion of purine bases and oxyPurinol. Eur J ClinInvest, 2000, 30(10): 871-878.
6. 王慧华, 李开沪, 朱秀英. 微粒化非诺贝特与苯扎贝特治疗老年高脂血症和高尿酸血症的比较. 老年医学与保健, 1999, 5(2): 73-75.
7. Elisaf M, Tsimichodimos V, Bairaktari E, et al. Effect of Micronized Fenofibrate and Losartan Combination on Uric Acid Metabolism in Hypertensive Patients with Hyperuricemia. Journal of Cardiovascular Pharmacology, 1999, 34(1): 60-63.
8. 张文姚, 任爱华, 蒋益忠. 自身交叉试验比较非诺贝特与辛伐他汀降脂疗效及对ApoA、ApoB的影响. 心血管康复医学杂志, 2000, 9(2): 35-37.
9. 王守俊, 刘瑞芳, 魏巧兰. 非诺贝特对糖尿病肾病的前瞻性研究. 辽宁实用糖尿病杂志, 2001, 9(3): 27-28.
10. Giral P, Bruckert E, Jacob N, et al. Homocysteine and lipid lowering agents. A comparison between atorvastatin and fenobrate in patients with mixed hyperlipidemia. Atherosclerosis, 2001, 154(2): 421-427.
11. Insua A, Massari F, Moncalvo JJR, et al. Fenofibrate of gemfibrozil for treatment of types IIa and IIb primary hyperlipoproteinemia: a randomized, double-blind, crossover study. Endocr Pract, 2002, 8(2): 96-101.
12. 秦利, 殷峻, 邢惠莉. 非诺贝特缓释微丸对糖尿病患者糖脂代谢紊乱的影响. 上海第二医科大学学报, 2003, 23(3): 261-263.
13. Milionis HJ, Papakostas J, Kakafika A, et al. Comparative effects of atorvastatin, simvastatin, and fenofibrate on serum homocysteine levels in patients with primary hyperlipidemia. J Clin Pharmacol, 2003, 43(8): 825-830.
14. 孙学春. 微粒化非诺贝特对老年人血脂代谢紊乱的疗效观察. 四川医学, 2005, 26(9): 975-976.
15. Filippatos TD, Kiortsis DN, Liberopoulos EN, et al. Effect of orlistat, micronised fenofibrate and their combination on metabolic parameters in overweight and obese patients with the metabolic syndrome: the FenOrli study. Curr Med Res Opin, 2005, 21(12): 1997-2006.
16. 刘玉庆, 史淑琴, 赵勇. 逐酸活血汤治疗原发性高尿酸血症并高三酰甘油血症30例的疗效观察. 中国实用医药, 2008, 3(34): 60-62.
17. Ansquer JC, Dalton RN, Caussé E, et al. Effect of fenofibrate on kidney function: a 6-week randomized crossover trial in healthy people. Am J Kidney Dis, 2008, 51(6): 904-913.
18. 王一扬, 王亦凡, 高振英. 非诺贝特治疗高甘油三酯症和高尿酸症的疗效. 药学与临床, 2009, 12(12): 1787-1789.
19. 刘茜. 非诺贝特和普伐他汀调节血脂及尿酸的研究. 中华全科医学, 2010, 8(1): 60-62.
20. 王大鹏, 高燕燕. 非诺贝特和苯溴马隆治疗高尿酸血症的效果. 齐鲁医学杂志, 2010, 25(6): 524-527.
21. Goto M. A comparative study of anti-inflammatory and antidyslipidemic effects of fenofibrate and statins on rheumatoid arthritis. Mod Rheumatol, 2010, 20(3): 238-243.
22. Filippatos TD, Kiortsis DN, Liberopoulos EN, et al. Effect of orlistat, micronised fenofibrate and their combination on metabolic parameters in overweight and obese patients with the metabolic syndrome: the FenOrli study. Curr Med Res Opin, 2005, 21(12): 1997-2006.
23. Milionis HJ, Elisaf MS. Management of hypertension and dyslipidaemia in patients presenting with hyperuricaemia: case histories. Curr Med Res Opin, 2000, 16(3): 164-170.
24. Daskalopoulou SS, Tzovaras V, Mikhailidis DP, et al. Effect on serum uric acid levels of drugs prescribed for indications other than treating hyperuricaemia. Curr Pharm Des, 2005, 11(32): 4161-4175.
25. Lipscombe J, Bargman JM. Fibrate-induced increase in blood urea and creatinine. Nephrol Dial Transplant, 2001, 16(7): 1515.
26. Davis TME, Ting R, Best JD, et al. Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study. Diabetologia, 2011, 54(2): 280–290.
27. Katsiki N, Papanas N, Fonseca VA, et al. Uric acid and diabetes: is there a link? Curr Pharm Des, 2013, 19(27): 4930-4937.

Chinese Journal of Evidence-Based Medicine

Effects of Fenofibrate on Kidney Function: A Meta-Analysis

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