The use of clofibrate in patients with renal insufficiency.

Serum clofibrinic acid (CPIB) levels after single and multiple oral doses of clofibrate were studied in 28 patients with elevated serum creatinine values. The half-life of CPIB was prolonged in proportion to the serum creatinine level (r = 0.818 p less than 0.001). Peak CPIB concentrations in serum were not affected by azotemia, although CPIB levels 24 h after a single dose and under steady-state conditions correlated well with the serum creatinine level. The proportion of unbound CPIB was higher in patients with renal insufficiency than in controls (13.9% vs 4.3%), although this difference did not correlate with the serum creatinine level. Hypolipidemic medication is indicated in dyslipoproteinemias associated with renal insufficiency. If a reduced dose is given, clofibrate can be used safely in renal patients, although a CPIB concentration of 70 mg/l in serum should not be exceeded unless the unbound fraction has been measured and found not to exceed a safe level (i.e., 6 mg/l CPIB).