Effects of fenofibrate therapy on renal function in primary gout patients.
Effects of fenofibrate therapy on renal function in primary gout patients.
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非诺贝特治疗对原发性痛风患者肾功能的影响
DOI：
10.1093/rheumatology/keab231
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发表时间：
2021-11-03
期刊：
影响因子：
--
通讯作者：
Li C
中科院分区：
文献类型：
--
作者：
Li X;Sun W;Lu J;He Y;Chen Y;Ren W;Cui L;Liu Z;Wang C;Wang X;Ma L;Cheng X;Han L;Li H;Zhang H;Yuan X;Ji X;Ji A;Merriman TR;Li C
调查痛风患者非诺贝特相关肾毒性的发生率和潜在危险因素。从电子病历系统中回顾性纳入2016年9月至2020年6月期间在青岛大学附属医院痛风专科门诊就诊的接受非诺贝特治疗的痛风患者983例。非诺贝特相关肾毒性定义为非诺贝特开始使用后 6 个月内血清肌酐 (SCr) 增加≥0.3mg/dl。采用广义加性混合模型（GAMM）评估治疗期间SCr和尿酸水平的变化趋势。对影响 SCr 升高的危险因素进行多变量分析。在非诺贝特开始治疗后 6 个月内，共有 100 名患者 (10.2%) 出现 SCr 升高≥0.3mg/dl。整个队列中 SCr 的中位变化为 0.11mg/dl [四分位距 (IQR) 0.03-0.20]，而非诺贝特相关肾毒性组的中位变化为 0.36 (0.33-0.45)。在多变量回归模型中，慢性肾脏病 (CKD) [比值比 (OR) 2.39 (95% CI 1.48, 3.86)] 和痛风石 [OR 2.29 (95% CI 1.39, 3.78)] 被确定为非诺贝特相关肾毒性的风险预测因子，与测量的协变量无关。在治疗期间，虽然SCr暂时升高，但通过GAMM的相互作用分析，血清尿酸和甘油三酯浓度降低。在有非诺贝特戒断记录的患者中，65% 的患者 SCr 升高在平均停药 49 天后得到逆转。这项观察性研究表明，非诺贝特相关的肾毒性经常发生在痛风患者中，尤其是痛风石或慢性肾病患者中。非诺贝特用于治疗痛风的潜在肾脏风险需要进一步研究。
To investigate the incidence and potential risk factors for development of fenofibrate-associated nephrotoxicity in gout patients. A total of 983 gout patients on fenofibrate treatment who visited the dedicated Gout Clinic at the Affiliated Hospital of Qingdao University between September 2016 and June 2020 were retrospectively enrolled from the electronic records system. Fenofibrate-associated nephrotoxicity was defined as an increase in serum creatinine (SCr) ≥0.3 mg/dl within 6 months of fenofibrate initiation. The change trend of SCr and uric acid levels during the treatment period were assessed by a generalised additive mixed model (GAMM). Multivariate analysis was performed for risk factors affecting elevated SCr. A total of 100 (10.2%) patients experienced an increase in SCr ≥0.3 mg/dl within 6 months after fenofibrate initiation. The median change of SCr in the whole cohort was 0.11 mg/dl [interquartile range (IQR) 0.03–0.20], whereas it was 0.36 (0.33–0.45) in the fenofibrate-associated nephrotoxicity group. In a multivariable regression model, chronic kidney disease (CKD) [odds ratio (OR) 2.39 (95% CI 1.48, 3.86)] and tophus [OR 2.29 (95% CI 1.39, 3.78)] were identified to be risk predictors, independent of measured covariates, of fenofibrate-associated nephrotoxicity. During the treatment period, although SCr temporarily increased, serum urate and triglyceride concentrations decreased using the interaction analysis of GAMM. Of those with fenofibrate withdrawal records, the SCr increase in 65% of patients was reversed after an average of 49 days off the drug. This observational study implied that fenofibrate-associated nephrotoxicity occurs frequently in gout patients, especially in patients with tophi or CKD. The potential renal risks of fenofibrate usage in gout needs additional research.
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