From the FDA Drug Label
2.4 Impaired Renal Function Treatment with fenofibrate tablets should be initiated at a dose of 54 mg per day in patients having mild to moderately impaired renal function and increased only after evaluation of the effects on renal function and lipid levels at this dose. The use of fenofibrate tablets should be avoided in patients with severe renal impairment [see Use in Specific Populations (8.6) and Clinical Pharmacology (12.3)].
The dose of fenofibrate for a patient with CKD 4 (severe renal impairment) is not explicitly stated, but it is recommended to avoid the use of fenofibrate tablets in such patients 1.
From the Research
There is no medication called "Genfibrizol" in current medical practice, and if referring to a fibrate, extreme caution is needed in chronic kidney disease stage 4 (CKD 4) due to increased risk of myopathy and worsening kidney function. For patients with CKD stage 4 (eGFR 15-29 ml/min), fibrates like fenofibrate and gemfibrozil are generally contraindicated or require significant dose reduction due to the risks mentioned above 2, 3. Some studies suggest that fenofibrate may have benefits in delaying the need for dialysis and reducing cardiovascular risk in advanced CKD patients 4. However, the most recent and highest quality study on the use of fibrates in CKD patients suggests that pemafibrate, a selective peroxisomal proliferator-activated receptor α modulator, may be an effective and safe treatment for hypertriglyceridemia in CKD patients, with a marked improvement in eGFR compared to bezafibrate or fenofibrate 5. Given the potential risks and benefits, alternative medications like moderate-intensity statins with appropriate dose adjustments would typically be recommended for lipid management in CKD 4, and any lipid-lowering therapy should be initiated only after careful consideration and consultation with a nephrologist. Key considerations include:
- Close monitoring of kidney function, muscle symptoms, and regular laboratory testing
- Careful evaluation of the risks and benefits of lipid-lowering therapy in advanced CKD
- Consultation with a nephrologist before starting any lipid-lowering medication in advanced kidney disease
- Potential benefits of pemafibrate in CKD patients with hypertriglyceridemia, as suggested by recent studies 5.