Fibrates have been shown to increase creatinine levels in randomized trials

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A population-based study has shown an association between new fibrate use in older patients and nephrologist consultations and hospital admissions for a rise in creatinine level [1].

Though the rise may prompt clinical concern but it is uncertain that the changes in creatinine reflect renal injury.

The results of FIELD trial has shown that the increase in serum creatinine with fenofibrate was reversible on discontinuation, and at the end of the trial fenofibrate treatment appeared to have slowed loss of renal function and reduced proteinuria [2].

References

1. Zhao YY, Weir MA, Manno M, et al. New fibrate use and acute renal outcomes in elderly adults: a population-based study. Ann Intern Med 2012;156:560.
2. Davis TM, Ting R, Best JD, et al. Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study. Diabetologia 2011;54:280.

Norepinephrine in septic shock

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Patients on dopamine during septic shock have increased mortality compared with patients who receive norepinephrine. A meta-analysis of six randomized trials (1408 patients) compared dopamine with norepinephrine in septic shock and showed that Patients who received dopamine had a higher 28-day mortality rate than patients who received norepinephrine. Arrhythmic events were two times more common with dopamine than norepinephrine. Norepinephrine is preferable to dopamine as a vasopressor in the management of septic shock (Crit Care Med 2012;40:725).

Sodium phosphate enemas in the elderly should be avoided

Health Care Comments Off

Sodium phosphate enemas are used in the treatment of constipation and for preparation for flexible sigmoidoscopy. Sodium phosphate enema use in older adults (mean age 80 years, range 61 to 89 years) is associated with hypotension, volume depletion, hyperphosphatemia, hypo- or hyperkalemia, metabolic acidosis, severe hypocalcemia, renal failure and EKG changes (prolonged QT interval). In patients over the age of 70 years use warm water enemas rather than sodium phosphate enemas.

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