Current perspectives on lipid management in diabetic kidney disease: Can fibrates offer advantages over statins for renal outcomes?

Diabetic kidney disease (DKD) affects 30%-40% of patients with diabetes mellitus (DM). Dyslipidemia is a key modifiable risk factor for the development and progression of DKD. Statins remain the mainstay of lipid management in DM, but concerns exist about their renal effects and limited impact on high-density lipoprotein (HDL) and triglycerides. Fibrates, which primarily target HDL elevation and triglyceride reduction, have shown promise in addressing the lipid profile most relevant to DKD; however, they initially raise serum creatinine levels. This review aims to compare the effects of statins and fibrates on the development and progression of DKD, examining their mechanisms of action, clinical evidence, and limitations of current research. A comprehensive search of PubMed, Scopus, and Web of Science identified clinical studies published from 2000 onward, evaluating the renal effects of statins and/or fibrates in patients with DM, focusing on kidney function, damage markers, and disease progression. According to our findings, statins offer modest, short-term kidney protection; however, their long-term renal effects, and their limited impact on the specific dyslipidemia pattern associated with DKD, are a concern. Fibrates, which more effectively target triglycerides and HDL, show promise in preserving kidney function, though their use may be limited in advanced kidney disease. While some evidence suggests fibrates may be superior, especially in patients with low HDL and high triglycerides, more long-term studies are needed to confirm their definitive advantage over statins. Future research should focus on long-term studies with comprehensive assessments of kidney function.