Effect of Pemafibrate on Serum Creatinine in Patients with Chronic Kidney Disease

Introduction: Fibrates are recommended not to be used for the treatment of hypertriglyceridemia in patients with chronic kidney disease (CKD) based on clinical practice guidelines. The major reason for the negative suggestion is the elevation of serum creatinine and rhabdomyolysis by fibrates. This may cause clinical inertia for the treatment of hypertriglyceridemia using fibrate in patients with CKD, who are associated with an increasing risk of cardiovascular disease. Methods: We retrospectively studied the change of serum creatinine via the treatment of pemafibrate. Results: A total of 39 patients with CKD were treated with 0.2 mg of pemafibrate. Serum triglyceride was decreased in 23 fibrate-naive patients from 380 [308, 455] mg/dL to 180 [152, 215] mg/dL via treatment with pemafibrate (p = 0.00003). Serum creatinine and eGFR were not changed from 1.22 +/- 0.29 mg/dL to 1.21 +/- 0.28 mg/dL (p = 0.70) and from 45.7 +/- 10.9 mL/min/1.73 m2 to 46.2 +/- 12.0 mL/min/1.73 m2 (p = 0.67) via treatment with pemafibrate, respectively. In 16 patients, with a change of treatment from fenofibrate or bezafibrate to pemafibrate, serum creatinine was significantly decreased from 1.32 +/- 0.36 mg/dL to 1.17 +/- 0.24 mg/dL (p = 0.003). eGFR was significantly increased from 45.2 +/- 9.9 mL/min/1.73 m2 to 50.1 +/- 8.6 mL/min/1.73 m2 (p = 0.001). Conclusions: These results suggest that treatment with pemafibrate does not affect the serum creatinine level and is suitable for use in patients with CKD for the treatment of hypertriglyceridemia.