ACCORD Lipid, the other large randomized trial which investigated the effect of fibrates in type 2 diabetic patients, assessed the addition of fenofibrate 160 mg daily to simvastatin 10 40 mg daily (dose modified over time in response to changing guidelines) in 5518 participants.96 Again, this study excluded patients with impaired kidney function, creatinine 4133 mmol/l (41.5 mg/dl), such that only 141 participants had baseline eGFR below 50 ml/min/ . Ultimately too few participants with eGFR o60 ml/ were included in either FIELD or ACCORD Lipid to provide reliable information on either the safety or efficacy of fenofibrate in this group. A recent large observational study in patients aged Z66 years demonstrated a clear association between new prescriptions for fibric acid derivatives and increased SCr levels, as well as a small increase in the risk of hospitalization and nephrologist consultation.97 These findings contribute to the uncertainty that fibric acid derivatives would yield net clinical benefit in people with CKD. For these reasons, use of fibric acid derivatives to reduce cardiovascular risk is not recommended in patients with CKD. Suggested Audit Criteria Given the lack of evidence to support this recommendation, no audit criteria are suggested. KEY POINTS K TLC should be recommended to adults with CKD and hypertriglyceridemia. K Fibric acid derivatives are not recommended to prevent pancreatitis or reduce cardiovascular risk in adults with CKD and hypertriglyceridemia. RESEARCH RECOMMENDATIONS K There are currently no published randomized trials of fibric acid derivatives in CKD populations and too few participants with CKD were included in previous trials to provide reliable information. Other agents, such as niacin and the cholesteryl ester transfer protein inhibitor anacetrapib are currently being investigated in clinical trials in the general population and deserve investigation in CKD patients. 