Farmer's lung is a form of hypersensitivity pneumonitis, which is manifested mainly as an occupational disease among dairy farmers exposed to organic dusts from moldy hay and compost in silos and lofts. In Europe and America, it has been known for many years. In Japan, it frequently occurs in Hokkaido, Iwate and Hokuriku districts during winter months from November to March. The culprit antigens are spores of actinomycetes thermophilus such as Micropolyspora faeni and Thermoactinomyces vulgaris. In recent years, various preventive measures have been taken. For instance, in order to prevent hay from heating by fermentation and the thermophile from thriving, farmers desiccate hay as much as possible and keep it in air-tight plastic containers. The result is a notable decrease in the prevalence rate of this ailment. Nonetheless, with graying the rural population, pulmonary fibrosis caused by chronic exposure to low levels of organic dust is posing a grave health problem in the dairy farming communities. As a prophylactic measure against chronic fibrotic lung disease, there is a need to implement a comprehensive heath control program consisting of continual sanitary checkups at workplace and counseling at an early stage in addition to periodic health examinations. Another health threat which has more recently loomed up in the dairy farming communities is environmental pollution.

Background: Fibrates have renal toxicity limiting their use in subjects with chronic kidney disease (CKD). However, pemafibrate has fewer toxic effects on renal function. In the present analysis, we evaluated the effects of pemafibrate on the renal function of diabetic subjects with or without CKD in a real-world clinical setting. Methods: We performed a sub-analysis of data collected during a multi-center, prospective, observational study of the effects of pemafibrate on lipid metabolism in subjects with type 2 diabetes mellitus complicated by hypertriglyceridemia (the PARM-T2D study). The participants were allocated to add pemafibrate to their existing regimen (ADD-ON), switch from their existing fibrate to pemafibrate (SWITCH), or continue conventional therapy (CTRL). The changes in estimated glomerular filtration rate (eGFR) over 52 weeks were compared among these groups as well as among subgroups created according to CKD status. Results: Data for 520 participants (ADD-ON, n=166; SWITCH, n=96; CTRL, n=258) were analyzed. Of them, 56.7% had CKD. The eGFR increased only in the SWITCH group, and this trend was also present in the CKD subgroup (P<0.001). On the other hand, eGFR was not affected by switching in participants with severe renal dysfunction (G3b or G4) and/or macroalbuminuria. Multivariate analysis showed that being older and a switch from fenofibrate were associated with elevation in eGFR (both P<0.05). Conclusion A switch to pemafibrate may be associated with an elevation in eGFR, but to a lesser extent in patients with poor renal function.