Fibrate use in elderly patients

Fibrate use in elderly patients is associated with worsening renal function and increased risk of hospitalization, according to a new study. Researchers reviewed data from a large Canadian database of patients over the age of 65 who were started on a fibrate or ezetimibe (comparator). Many patients in both groups were also on statins. Fibrate users were more likely to be hospitalized for an increase in serum creatinine (odds ratio [OR] 2.4 [95% confidence interval (CI), 1.7 to 3.3]). Fibrate patients were also more likely to consult a nephrologist, but there was no difference in all-cause mortality or need for dialysis. In a subgroup of 1110 patients in which serum creatinines were available at baseline and within 90 days, 9.1% of fibrate users and 0.3% of ezetimibe users had an increase in serum creatinine of 50% or more (OR 29.6 [CI, 8.7 to 100.5]). The risk was higher if patients had chronic kidney disease. The authors conclude that new fibrate use in the elderly is associated with an increase in serum creatinine and a small increase in hospitalization and nephrology consultation (Ann Intern Med 2012;156:560-569).