대한신장학회

논문분류	춘계학술대회 초록집
제목	Long-term Fenofibrate Use and Risk of Renal Function Decline and ESRD in Patients with Chronic Kidney Disease Stages 3-4: A Multicenter Cohort Study
저자	Sojung Youn
출판정보	2026; 2026(1):
키워드	Fenofibrate, CKD stages 3-4, A Multicenter Cohort Study, Clinical Data Warehouse (CDW)
초록	Objectives: Fenofibrate has raised concerns regarding renal safety in patients with chronic kidney disease (CKD). This study aimed to evaluate the impact of long-term fenofibrate use on renal function decline and mortality among patients with CKD stages 3-4 in a real-world clinical setting. Methods: We conducted a retrospective multicenter cohort study using Clinical Data Warehouse (CDW) from eight university hospitals in Korea. CKD stages 3-4 patients treated between 2000 and 2024 were identified and followed for at least one year. Patients with a history of fenofibrate use were compared with non-users. Primary endpoints were progression to end-stage renal disease (ESRD) and annual decline in estimated glomerular filtration rate (eGFR). Secondary endpoints included all-cause mortality and major adverse cardiovascular events (MACE). Propensity score matching (PSM) was performed to balance baseline characteristics, and Cox proportional hazards models were used to estimate hazard ratios. Results: Among 59,842 screened patients, 1,191 were included in the final analysis (fenofibrate users, n=292; non-users, n=899). After PSM, 292 matched pairs were analyzed. The mean age was 61.13 years in fenofibrate group and 61.11 in the control group. The fenofibrate group showed higher baseline comorbidities, including diabetes (72.95% vs. 48.97%), hypertension (88.36% vs. 66.44%), and ischemic heart failure (15.75% vs. 7.19%). In multivariable Cox proportional hazards analysis, fenofibrate use was independently associated with a higher risk of progression to ESRD (HR 1.66, 95% CI 1.143–2.412, p=0.0078). No significant differences were observed in all-cause mortality (p=0.0573) or MACE (p=0.1066). The annual decline in eGFR was significantly greater in the fenofibrate group (slope −1.545, 95% CI −1.96 to −1.13, p<0.0001). Conclusion: In patients with CKD stages 3-4, long-term fenofibrate use was associated with a faster decline in renal function and a higher risk of progression to ESRD. These findings suggest that careful consideration is warranted when prescribing fenofibrate to those patients.
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