The Effect of Fibrates on Kidney Function: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: Randomized controlled trials (RCTs) have investigated the effects of fibrates on cardiovascular events. Fibrates are known to cause an acute decline in estimated glomerular filtration rate (eGFR) but their long-term effect on kidney function is unclear. Some trials have indicated that following the acute decline fibrates improve the long-term rate of eGFR decline. We conducted a systematic review and meta-analysis to elucidate the impact of fibrates on kidney function. Methods: This review was prospectively registered on PROSPERO (CRD42023377211) and conducted according to the PRISMA 2020 guidelines. Literature searches were conducted in MEDLINE, EMBASE, CINAHL and Scopus. Inclusion criteria were RCTs in adults comparing fibrates to placebo or active comparator that reported eGFR at at least two timepoints. Screening, data extraction and risk of bias assessments were conducted in-duplicate. Random-effects, restricted maximum likelihood, inverse variance meta-analyses were used to pool treatment effects. Primary outcomes included the effect on acute change in eGFR (defined as within the first 4 months), chronic eGFR slope (defined as the eGFR slope following the acute period) and post-washout eGFR. Additional outcomes were change in albuminuria and the incidence of ESRD. Results: Fifteen (N=16,957) eligible RCTs were included. When compared to control, fibrates led to an acute decline in eGFR (MD -9.53 ml/min/1.73 m2; 95% CI -12.12 to -6.94) that was present at the end of the study period as well (MD -6.29 ml/min/1.73 m2; 95% CI -14.64 to -2.06). Based on the data available, we were unable to meta-analyze the effect of fibrates on chronic slope. However, two RCTs reported a beneficial effect of fibrates on chronic eGFR slope (-1.19 vs -2.03 ml/min/1.73 m2 per year and -0.27 vs -1.26 ml/min/1.73 m2 per year, p<0.001). Following washout, fibrates improved eGFR as compared to control (MD 3.60 ml/min/1.73 m2; 95% CI 0.02 to 7.17). Fibrates reduced albuminuria (MD -0.17 mg/g; 95% CI -0.25 to -0.10). There was no statistically significant effect on ESRD (RR 0.93; 95% CI 0.71 to 1.22). Conclusions: Fibrates cause an acute decline in eGFR and an improvement in the rate of eGFR decline thereafter. Further studies are needed to determine the long-term impact of fibrates on renal function.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.044 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.036 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".