Randomized treatment trials that examined the effect of fibrates relative to placebo in patients with diabetes and CKD are summarized below. The Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT) found evidence that gemfibrozil reduces risk of major cardiovascular events (i.e., fatal CHD, nonfatal MI, and stroke) by 42% compared with placebo (RR 0.58; 95% CI 0.38 0.89) in a post hoc analysis of ) The Diabetes Atherosclerosis Intervention Study (DAIS)92 and the FIELD study93 reported that fenofibrate treatment significantly lowered the risk of developing new-onset microalbuminuria compared with placebo (RR 0.87 in patients with type 2 diabetes; 95% CI 0.77-0.97). In a pooled analysis of these two trials, fenofibrate also promoted regression from microalbuminuria to normoalbuminuria (RR1.15; 95% CI 1.04 1.28; n 2260). None of the other trials of fibrate therapy in diabetes reported CVD or kidney disease outcomes for the subgroup of patients with CKD. The FIELD study was a large randomized double-blind trial in which 9795 participants aged 50 75 years with type 2 chapter 5 http://www.kidney-international.org & 2013 KDIGO diabetes were allocated to micronized fenofibrate 200 mg daily or matching placebo, and followed for a median of Patients were eligible if there was no clear indication for, or treatment with, lipid-modifying therapy at study entry, and patients with renal impairment, defined as a plasma creatinine 4130 mmol/l (41.47 mg/dl), were excluded. There was a significant difference in the proportion of participants with progression of albuminuria, analyzed categorically to/from normo-, micro-, and macro-albumin- the fenofibrate group vs. 539 [11.0%] progressing and 400 [8.2%] regressing in the placebo group; i.e., 2.6% more patients were regressing or not progressing in those allocated fenofibrate than placebo, p 0.002). 