Compared with other end-organ complications of metabolic diseases, fewer clinical studies have evaluated the potential value of PPAR modulation in kidney diseases, perhaps due to concerns regarding reversible increases in serum creatinine following fibrate initiation as well as oedema and heart failure risks following TZD treatment.29 30 For example, no randomised controlled studies of fibrates with a primary renal outcome have been performed in people with T2DM. This evidence concerns the gene PPARA and kidney disorder.