Factors Associated With Fibrate-Induced Creatinine Elevation: Observations in an Outpatient Setting

Ahmed Abbas, Sanjay Saraf, Shanath Ramachandran, Jessie Raju, Sudarshan Ramachandran


Background: A reversible rise in creatinine with fibrates has been previously documented. However, this phenomenon remains poorly understood with no associated factors described. We wished to study changes seen in creatinine following fibrate therapy in a routine outpatient setting and identify related risk factors.

Methods: Data was collected from the records of patients started on fibrates (n = 132) in the lipid clinic at Good Hope Hospital, Sutton Coldfield between 2002 and 2008. Pre and post-fibrate creatinine concentrations were obtained from the pathology database. Creatinine was measured using the Jaffe method on the Roche modular P Unit.

Results: Fenofibrate was used in 117 (88.6%) patients while the remaining 15 patients were on bezafibrate. Creatinine increased from a mean of 81.9 (sd = 17.3, median = 83, range: 33 - 127) umol/L to 93.8 (sd = 20.4, median = 91, range: 52 - 143) umol/L following fibrate treatment. Regression analyses showed that male gender (coefficient = 6.64 (95% CI: 0.99/12.29), P = 0.022), pre-treatment creatinine concentration (coefficient = -0.20 (95% CI: -0.35/-0.046), P = 0.011), diabetes (coefficient = -6.37 (95% CI: -12.36/-0.38), P = 0.037) and change inTG (coefficient: -1.02, 95% CI -1.39/-0.65, P<= 0.001) were significantly associated with creatinine change. All the above remained significant when entered into a multiple regression model suggesting independence.

Conclusions: This study confirms that creatinine increased in our group of patients when fibrates were commenced. Further studies are required to confirm and further explore our findings.



Fibrates; Creatinine; Triglycerides; PPARa; Diabetes mellitus

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