Evaluation of the effects of ezetimibe on albuminuria and kidney fat in individuals with type 2 diabetes and chronic kidney disease

Abstract Aim To investigate the effects of ezetimibe on the urine albumin creatinine ratio (UACR) and kidney parenchyma fat content (kidney‐PF) in individuals with type 2 diabetes (T2D) and early chronic kidney disease. Materials and Methods A randomized, double‐blind, placebo‐controlled study of ezetimibe 10 mg once daily for 16 weeks in individuals with T2D and a UACR of 30 mg/g or higher was conducted. Kidney‐PF was assessed with magnetic resonance spectroscopy. Geometric mean changes from baseline were derived from linear regressions. Results A total of 49 participants were randomized to ezetimibe ( n = 25) or placebo ( n = 24). Overall, mean ± standard deviation age was 67 ± 7 years, body mass index was 31 ± 4 kg/m 2 and the proportion of men was 84%. The mean estimated glomerular filtration rate was 76 ± 22 mL/min/1.73m 2 and median (first‐third quartile) UACR was 95 (41‐297) mg/g. Median kidney‐PF was 1.0% (0.3%‐2.1%). Compared with placebo, ezetimibe did not significantly reduce UACR (mean [95% confidence interval] change: −3% [−28%‐31%]) or kidney‐PF (mean change: −38% [−66%‐14%]). In participants with baseline kidney‐PF above the median, ezetimibe reduced kidney‐PF significantly (mean change: −60% [−84%‐−3%]) compared with placebo, while the reduction in UACR was not significant (mean change: −28% [−54%‐15%]). Conclusions Ezetimibe did not reduce the UACR or kidney‐PF on top of modern T2D management. However, kidney‐PF was reduced with ezetimibe in participants with high baseline kidney‐PF.