RISK OF MAJOR ADVERSE KIDNEY EVENTS OF TRIGLYCERIDE-TARGETING LIPID-LOWERING THERAPIES VERSUS STATINS IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Author(s)
Mohammad Abdullah Al Zubair Naim, MPharm1, Fridtjof Thomas, PhD2, Elani Streja, MPH, PhD3, Robert Davis, MD, MPH4, Kamyar Kalantar-Zadeh, MD, PhD5, Keiichi Sumida, MD, MPH, PhD1, Csaba P. Kovesdy, MD1;
1The University of Tennessee Health Science Center, Medicine, Memphis, TN, USA, 2The University of Tennessee Health Science Center, Preventive Medicine, Memphis, TN, USA, 3University of California, Irvine, Medicine, Orange, CA, USA, 4The University of Tennessee Health Science Center, Memphis, TN, USA, 5Harbor-UCLA Medical Center, Medicine, Los Angeles, CA, USA
1The University of Tennessee Health Science Center, Medicine, Memphis, TN, USA, 2The University of Tennessee Health Science Center, Preventive Medicine, Memphis, TN, USA, 3University of California, Irvine, Medicine, Orange, CA, USA, 4The University of Tennessee Health Science Center, Memphis, TN, USA, 5Harbor-UCLA Medical Center, Medicine, Los Angeles, CA, USA
OBJECTIVES: Triglyceride (TG)-targeting lipid-lowering therapies (LLTs), such as fibrates and niacin, are often used to treat dyslipidemia in patients with CKD due to their TG-lowering and HDL-elevating effects. However, in non-dialysis-dependent patients with CKD (NDD-CKD), the risk of these therapies on major adverse kidney events (MAKE) is under-investigated. We therefore compared the risk of MAKE in NDD-CKD patients with CKD when initiating fibrates or niacin versus statins as the standard treatment.
METHODS: We designed a retrospective cohort study using the target trial emulation framework. We leveraged data from a nationwide cohort of 3,562,882 US Veterans to identify 68,073 patients with incident CKD who initiated de novo fibrate, niacin, or statin therapy and followed up these patients for up to 10 years. We then compared the risk of MAKE (a composite of a sustained 57% decrease in eGFR from baseline, sustained eGFR<15 mL/min/1.73 m2, incident end-stage renal disease, and all-cause death) in fibrate and niacin initiators with statin initiators using Cox proportional hazards models adjusted for sociodemographic status, vital signs and laboratory measurements, history of medication use, comorbidities, and Charlson Comorbidity Index.
RESULTS: A total of 21,102 patients experienced MAKE during a median follow-up of 3.69 years. The crude event rate was higher in patients initiating statins (74.3 per 1000 person-years [PY]) than in those initiating fibrates (55.2 per 1000 PY) or niacin (62.8 per 1000 PY). However, in adjusted models, the risk of MAKE was not significantly different in fibrate (hazards ratio [HR], 0.94 [95% CI, 0.88, 1.01], p=0.09) or niacin (HR, 0.96 [0.89, 1.04], p=0.30) users.
CONCLUSIONS: Among patients with NDD-CKD, de novo long-term fibrate or niacin use was not associated with an increased risk of MAKE compared to the standard treatment, statin. Further studies are warranted to investigate the association of TG-targeting LLTs with adverse cardiovascular events.
METHODS: We designed a retrospective cohort study using the target trial emulation framework. We leveraged data from a nationwide cohort of 3,562,882 US Veterans to identify 68,073 patients with incident CKD who initiated de novo fibrate, niacin, or statin therapy and followed up these patients for up to 10 years. We then compared the risk of MAKE (a composite of a sustained 57% decrease in eGFR from baseline, sustained eGFR<15 mL/min/1.73 m2, incident end-stage renal disease, and all-cause death) in fibrate and niacin initiators with statin initiators using Cox proportional hazards models adjusted for sociodemographic status, vital signs and laboratory measurements, history of medication use, comorbidities, and Charlson Comorbidity Index.
RESULTS: A total of 21,102 patients experienced MAKE during a median follow-up of 3.69 years. The crude event rate was higher in patients initiating statins (74.3 per 1000 person-years [PY]) than in those initiating fibrates (55.2 per 1000 PY) or niacin (62.8 per 1000 PY). However, in adjusted models, the risk of MAKE was not significantly different in fibrate (hazards ratio [HR], 0.94 [95% CI, 0.88, 1.01], p=0.09) or niacin (HR, 0.96 [0.89, 1.04], p=0.30) users.
CONCLUSIONS: Among patients with NDD-CKD, de novo long-term fibrate or niacin use was not associated with an increased risk of MAKE compared to the standard treatment, statin. Further studies are warranted to investigate the association of TG-targeting LLTs with adverse cardiovascular events.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO162
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Urinary/Kidney Disorders