, 2.6% more patients were regressing or not progressing in those allocated fenofibrate than placebo, p 0.002). Importantly, only 5% (519 of 9795) of the randomized participants had a baseline , so only 117 cardiovascular events occurred in this subgroup. The significant treatment effects presented for those with eGFR below 60 ml/min/ (for the outcomes of coronary revascularization, cardiovascular mortality, and total cardiovascular events) were based on too few events to be reliable. Hence, there was not good evidence that the treatment effects on vascular outcomes differed between those with and without lower baseline eGFR. Ting and colleagues also considered whether allocation to fenofibrate affected renal function but were unable to conclusively address this issue due to lack of statistical Another paper, which provides more detailed renal analyses from FIELD, suggested that after excluding the 10 12 mmol/l (0.11 0.14 mg/dl) step-rise in creatinine on commencing fenofibrate, allocation to fenofibrate was in fact associated with a slower rate of change in eGFR (1.19 vs. per year; But the inaccuracy of eGFR above 60 ml/min/ and the use of surrogate outcomes such as rate of change in eGFR and albuminuria remain important caveats. Furthermore, allocation to fenofibrate was also associated with an increased risk of doubling of plasma creatinine be explained by the small step-rise in creatinine. 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/ . 