From the Guidelines
Fenofibrate can potentially harm renal function, particularly in patients with pre-existing kidney disease, and its use should be approached with caution in these patients. According to the most recent and highest quality study, the 2015 KDOQI US commentary on the 2013 KDIGO clinical practice guideline for lipid management in CKD 1, fenofibrate is contraindicated in individuals with eGFR < 30 mL/min/1.73m², and there are limited data about the safety of gemfibrozil in patients with advanced CKD.
The mechanism of fenofibrate-induced renal impairment appears to be related to altered renal hemodynamics rather than direct kidney damage. For patients with moderate to severe kidney disease (eGFR <60 mL/min/1.73m²), dose reduction is recommended, and the medication should be avoided in severe renal impairment (eGFR <30 mL/min/1.73m²). Regular monitoring of kidney function is essential when starting fenofibrate therapy, particularly during the first three months. If significant deterioration in renal function occurs, discontinuation of the medication should be considered. The kidney effects are usually reversible upon discontinuation of the medication.
Some key points to consider when using fenofibrate in patients with kidney disease include:
- Dose reduction is recommended for patients with moderate to severe kidney disease (eGFR <60 mL/min/1.73m²) 1
- Fenofibrate should be avoided in severe renal impairment (eGFR <30 mL/min/1.73m²) 1
- Regular monitoring of kidney function is essential when starting fenofibrate therapy, particularly during the first three months 1
- The concurrent use of statins and fibrates raises the risk for rhabdomyolysis, and the combination should not be used in CKD 1
Overall, while fenofibrate can be a useful medication for managing lipid disorders, its potential to harm renal function in patients with pre-existing kidney disease must be carefully considered, and its use should be approached with caution in these patients.
From the FDA Drug Label
Fenofibric acid is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. The use of fenofibrate should be avoided in patients who have severe renal impairment [see Contraindications (4)]. Dose reduction is required in patients with mild to moderate renal impairment [see Dosage and Administration (2.4) and Clinical Pharmacology (12.3)]. Monitoring renal function in patients with renal impairment is recommended.
Fenofibrate can cause impaired renal function. The drug is substantially excreted by the kidney, and the risk of adverse reactions may be greater in patients with impaired renal function. Patients with severe renal impairment should avoid using fenofibrate, and dose reduction is required in patients with mild to moderate renal impairment. Monitoring renal function in patients with renal impairment is recommended 2, 2, 2.