Effects of long-term fenofibrate treatment on markers of renal function in type 2 diabetes: the FIELD Helsinki substudy.
Effects of long-term fenofibrate treatment on markers of renal function in type 2 diabetes: the FIELD Helsinki substudy.
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DOI：
10.2337/dc09-0621
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发表时间：
2010-02
期刊：
影响因子：
16.2
通讯作者：
Taskinen MR
中科院分区：
文献类型：
--
作者：
Forsblom C;Hiukka A;Leinonen ES;Sundvall J;Groop PH;Taskinen MR
尽管在非诺贝特干预和降低糖尿病事件（FIELD）研究中，非诺贝特与白蛋白尿进展较少相关，但尚不清楚它是否对肾功能有任何影响。我们在排除他汀类药物使用者的FIELD赫尔辛基队列研究中探讨了非诺贝特治疗期间常用的肾功能标志物是否发生变化。170例2型糖尿病患者被随机分配接受微粒化非诺贝特（200 mg/天）或安慰剂治疗5年。在这个子研究中，我们测量了几种白蛋白排泄和肾功能的标志物。强化治疗后，两组血压和空腹血糖均下降，A1 C仍为7.2%。非诺贝特组血浆肌酐升高，而两组间尿肌酐保持相当，导致非诺贝特组肌酐清除率和肾脏疾病饮食改良（MDRD）-4和Cockroft-Gault方程估计的肾小球滤过率（eGFR）显著降低。Cystatin C在非诺贝特治疗期间增加。两组的尿白蛋白/肌酐比值和日间尿蛋白保持不变，而夜间尿白蛋白排泄率略有下降。我们报告非诺贝特伴随肌酐清除率和eGFR降低。这些变化使非诺贝特治疗期间的临床监测复杂化。我们不能证明非诺贝特对白蛋白排泄的有益作用。一个新的发现是2型糖尿病患者在非诺贝特治疗期间半胱氨酸蛋白酶抑制剂C增加。这些变化的临床相关性需要在肾功能的长期结局研究中进行评估。
Although fenofibrate was associated with less progression of albuminuria in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, it is unknown if it has any effect on renal function. We explored if there were changes in commonly available markers of renal function during fenofibrate treatment in the FIELD Helsinki cohort excluding statin users. One hundred and seventy subjects with type 2 diabetes were randomly assigned to micronized fenofibrate (200 mg/day) or placebo for 5 years. In this substudy, we measured several markers of albumin excretion and renal function. After intensified treatment, blood pressure and fasting glucose decreased in both groups while A1C remained at 7.2%. Plasma creatinine increased with fenofibrate while urine creatinine remained comparable between the groups, resulting in significant decreases in both creatinine clearance and estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease (MDRD)-4 and Cockroft-Gault equations in the fenofibrate group. Cystatin C increased during fenofibrate treatment. Urinary albumin-to-creatinine ratio and diurnal urine protein remained unchanged, whereas overnight urinary albumin excretion rate showed minor decreases in both groups. We report concomitant decreases in creatinine clearance and eGFR by fenofibrate. These changes complicate the clinical surveillance during fenofibrate treatment. We could not demonstrate the beneficial effects of fenofibrate on albumin excretion. A novel finding is the increase of cystatin C in type 2 diabetic patients during fenofibrate treatment. The clinical relevance of the changes needs to be assessed in a long-term outcome study of renal function.
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影响因子：
2.8
作者：
Roos, Juliana F.;Doust, Jenny;Kirkpatrick, Carl M. J.
通讯作者：
Kirkpatrick, Carl M. J.
影响因子：
13.2
作者：
Stevens, Lesley A.;Coresh, Josef;Levey, Andrew S.
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Ansquer, JC;Foucher, C;Steiner, G
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Steiner, G
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Klag, MJ
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作者：
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通讯作者：
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