What is the dosage of fenofibrate for a patient with impaired renal function, specifically an estimated Glomerular Filtration Rate (eGFR) of 70?

From the Guidelines

Fenofibrate can be safely prescribed at standard doses for patients with an eGFR of 70 ml/min/1.73m². For most formulations, the typical starting dose is 145 mg once daily (or 48-145 mg depending on the specific product) 1. No dose adjustment is required at this level of kidney function, as an eGFR of 70 represents only mild reduction in kidney function. However, it's essential to monitor kidney function periodically while on fenofibrate therapy, as the medication can potentially cause further decline in renal function in some patients.

Key Considerations

• Fenofibrate works by activating peroxisome proliferator-activated receptor alpha (PPAR-α), which reduces triglycerides and increases HDL cholesterol.
• Common side effects include gastrointestinal disturbances, elevated liver enzymes, and myalgia.
• If the patient's kidney function declines to an eGFR below 30 ml/min/1.73m², fenofibrate should be avoided or used at reduced doses with careful monitoring, as indicated by the guidelines 1.
• Additionally, monitor for drug interactions, particularly with statins, as the combination increases risk of myopathy.

Monitoring and Follow-Up

• Renal status should be evaluated before fenofibrate initiation, within 3 months after initiation, and every 6 months thereafter, assessing renal safety with both a serum creatinine level and an eGFR based on creatinine 1.
• The dose of fenofibrate should not exceed 54 mg/day if the eGFR is between 30 and 59 mL/min per 1.73 m2, and fenofibrate should be discontinued if the eGFR decreases persistently to 30 mL/min per 1.73 m2 1.

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 dose of fenofibrate for a patient with an eGFR of 70 should be initiated at 54 mg per day, as this indicates mild to moderately impaired renal function. The dose can be increased after evaluating the effects on renal function and lipid levels. 2

From the Research

Fenofibrate Use in Patients with eGFR 70

• The use of fenofibrate in patients with an estimated glomerular filtration rate (eGFR) of 70 mL/min/1.73 m^2 is supported by several studies 3, 4, 5.
• A study published in Diabetes Care found that fenofibrate reduced total cardiovascular events in patients with type 2 diabetes and moderate renal impairment, including those with an eGFR of 60-89 mL/min/1.73 m^2 3.
• Another study published in the European Journal of Clinical Investigation found that fenofibrate was associated with a slower progression of renal function impairment and albuminuria in patients with chronic kidney disease 4.
• A study published in The Journal of Clinical Endocrinology and Metabolism found that fenofibrate delayed the need for dialysis and reduced cardiovascular risk among patients with advanced chronic kidney disease 5.

Dose Adjustment in Patients with Renal Impairment

• The use of estimated glomerular filtration rate (eGFR) for dose adjustment of medications in patients with renal impairment is recommended 6, 7.
• A study published in BMC Geriatrics found that the choice of equation used to estimate GFR and the literature source consulted can have a significant impact on drug management in geriatric patients with renal impairment 6.
• A study published in Drugs & Aging found that the use of eGFR can help reduce the risk of overdosing drugs in elderly patients with renal impairment 7.

Safety and Efficacy of Fenofibrate in Patients with eGFR 70

• The safety and efficacy of fenofibrate in patients with an eGFR of 70 mL/min/1.73 m^2 have been established in several studies 3, 4, 5.
• Fenofibrate has been shown to be effective in reducing cardiovascular risk and delaying the need for dialysis in patients with advanced chronic kidney disease 5.
• However, patients with renal impairment should be closely monitored for changes in serum creatinine levels and renal function while taking fenofibrate 4.