Fenofibrate Dosing for eGFR 50
For a patient with an eGFR of 50 mL/min/1.73m², the recommended dose of fenofibrate is 48-54 mg per day. 1, 2
Dosing Rationale and Evidence
Fenofibrate requires dose adjustment in patients with renal impairment due to its metabolism and excretion patterns. The FDA-approved labeling provides specific guidance for patients with different levels of renal function:
- For patients with eGFR 30-59 mL/min/1.73m² (which includes our patient with eGFR 50), the dose should be reduced to 48-54 mg per day 2
- This dose reduction is necessary because patients with moderate renal impairment have:
Monitoring Recommendations
When prescribing fenofibrate to a patient with eGFR 50:
- Assess baseline renal function before starting therapy 1
- Monitor renal function within 3 months after initiation 1
- Continue monitoring every 6 months thereafter 1
- Evaluate both serum creatinine and eGFR 1
- Watch for significant increases in serum creatinine (≥0.1 mg/dL), which occurs in approximately 55% of patients on fenofibrate 3
Important Considerations and Cautions
- Fenofibrate causes an initial, reversible increase in serum creatinine (average 10.0 μmol/L) shortly after initiation 4
- This initial increase does not necessarily indicate worsening renal function but rather reflects hemodynamic changes 4
- Long-term studies suggest fenofibrate may actually slow eGFR decline over time compared to placebo, despite the initial creatinine elevation 4
- Fenofibrate should be discontinued if eGFR declines to <30 mL/min/1.73m² 1, 2
Special Warnings
- Avoid combining fenofibrate with high-dose statins in patients with CKD due to increased risk of myopathy 1
- Monitor for muscle symptoms and check creatine kinase if myalgia develops 2
- If using with statins, consider low to moderate-intensity statin doses only 1
- Administer fenofibrate with meals to optimize bioavailability 2
Clinical Benefit in Moderate Renal Impairment
Despite the need for dose reduction, evidence suggests that patients with moderate renal impairment (eGFR 30-59 mL/min/1.73m²) still benefit from fenofibrate therapy:
- The FIELD study demonstrated that patients with type 2 diabetes and moderate renal impairment had a 32% reduction in cardiovascular events with fenofibrate (HR 0.68 [0.47-0.97], p=0.035) 5
- Fenofibrate therapy was also associated with reduced albuminuria progression and greater albuminuria regression compared to placebo 4
By following the recommended reduced dose of 48-54 mg daily for a patient with eGFR 50, you can provide effective lipid management while minimizing the risk of adverse renal effects.