Fibrate-induced increase in blood urea and creatinine: is gemfibrozil the only innocuous agent?
Fibrate-induced increase in blood urea and creatinine: is gemfibrozil the only innocuous agent?
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DOI：
10.1093/ndt/15.12.1993
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发表时间：
2000-12-01
影响因子：
6.1
通讯作者：
Abramowicz, D
中科院分区：
文献类型：
--
作者：
Broeders, N;Knoop, C;Abramowicz, D
背景一些报告表明贝特类药物可引起肾功能不全。然而，这些事件的临床特征，以及四种主要贝特类药物（即非诺贝特、苯扎贝特、环丙贝特和吉非贝齐）各自的肾毒性仍不明确。为了更好地描述这种副作用，我们首先回顾了本机构27例在贝特类药物治疗期间发生肾功能损害的患者的病历。接下来我们分析了24篇包含贝特类药物治疗患者（n = 2676）肾功能数据的文章。在我们的27例患者中，25例接受非诺贝特治疗，1例服用苯扎贝特，1例服用环丙贝特。19例为实体器官移植受者（肾脏受者，n = 15;心脏或心肺受者，n = 4），8例为肾功能受损的非移植患者。基线血浆肌酐范围为0.9 - 2.9 mg/dl。贝特类药物治疗开始后，平均增加40%。大多数患者的血尿素值（平均36%）伴随增加。停用贝特类药物后，18/24例患者的肾功能恢复至基线水平。然而，6名患者，所有移植受者，经历了血浆肌酐的永久性增加。在我们的一系列肾移植受者中，贝特类药物诱导的肾功能不全的发生率为60%，因为在25例曾服用贝特类药物的患者中有15例发生了这种情况。所有关于非诺贝特（n = 7）和苯扎贝特（n = 8）的论文（范围分别为8 - 18%和8 - 40%）以及4篇关于环丙贝特的论文中的3篇（范围6 - 16%）均描述了治疗期间平均肌酐值的增加。在8篇报告吉非罗齐治疗数据的文章中，没有任何一篇描述了显著的肾损害。使用非诺贝特、苯扎贝特和环丙贝特治疗可能导致肾功能不全。吉非罗齐似乎没有这种副作用。
Background. Some reports indicate that fibrates can induce renal dysfunction. However, the clinical characteristics of these episodes, and the respective nephrotoxicity of the four main fibrates used-namely, fenofibrate, bezafrbrate, ciprofibrate, and gemfibrozil-remain ill defined.Methods. To better characterize this side-effect, we first reviewed the charts of 27 patients from our institution who developed an impairment of renal function during fibrate therapy. We next analysed the articles (n = 24) that contained data on renal function in patients taking fibrates (n = 2676).Results. Among our 27 patients, 25 were on fenofibrate therapy, one was taking bezafibrate, and one ciprofibrate. Nineteen were recipients of solid-organ transplants (kidney recipients, n = 15; heart or heart-lung recipients, n = 4), and eight were non-transplanted patients with some impairment of renal function. Baseline plasma creatinine ranged from 0.9 to 2.9 mg/dl. It increased by a mean of 40% after the start of fibrate therapy. There was a concomitant increase of blood urea values (mean 36%) in most of the patients. Renal function returned to baseline in 18/24 patients after fibrate discontinuation. However, six patients, all transplant recipients, experienced a permanent increase in plasma creatinine. The incidence of fibrate-induced renal dysfunction among our series of kidney transplant recipients was 60%, as it occurred in 15 of the 25 patients who had ever taken fibrates. An increase of mean creatinine values during therapy was described in all papers on fenofibrate (n = 7) and bezafibrate (n = 8) (range 8-18% and 8-40% respectively), and in three of four papers dealing with ciprofibrate (range 6-16%). No significant renal impairment was described in any of the eight articles reporting data on gemfibrozil therapy.Conclusion. Therapy with fenofibrate, bezafibrate, and ciprofibrate may induce renal dysfunction. Gemfibrozil appears to be devoid of this side-effect.