SP526TREATMENT WITH PCSK9 INHIBITORS IN PERITONEAL DIALYSIS

Abstract

INTRODUCTION AND AIMS: Cardiovascular disease is the most common cause of death in chronic kidney disease (CKD), including patients with renal replacement therapy (RRT). Patients treated with peritoneal dialysis (PD) tend to present dyslipidemia with high level of total cholesterol, low density lipoprotein cholesterol (LDL) and apolipoprotein B (apoB). Human monoclonal antibodies that inhibits proprotein convertase subtilisin/kexin type 9 (PCSK9) are a new therapeutic group that works at celular level increasing the LDL receptors and decreasing the circulating levels of LDL. There is no data of its use in patients with advanced CKD or on RRT. METHODS: Clinical case of a patient on peritoneal dialysis programtreated with Alirocumab is presented. 59-years old-malewith history of arterial hypertension and familiar dyslipidemia, no diabetes mellitus, no smoker.He started peritoneal dialysis inMay 2015 due to advanced kidney disease of unknown etiology. His cardiologic history includes multiple acute coronary events, reflecting amultivessel disease treatedwith several coronary angioplasties and drug-eluting stents implantation, affecting even the leftmain. The patient presented high levels of cholesterol and LDL despite ofmaximumtolerated doses of atorvastatin in conjunction with ezetimibe.Due to considering high risk for new cardiovascular events, treatment with Alirocumab 75 mgevery two weeks was decided. RESULTS: Table 1 shows the analytic results and follow-up. All results in mg/dl. LDL: low density lipoprotein cholesterol; HDL: high density lipoprotein cholesterol; VLDL: very low density lipoprotein cholesterol; TGC: Triglyceride; LpA: Lipoprotein A; Apo A1: Apolipoprotein A1; Apo B: Apolipoprotein B. Index ApoB/Apo A > 1 shows higher atherogenics lipoproteins load. Neither side effects nor complications were reported. CONCLUSIONS: Treatment with alirocumab was effective and safe in our case. Randomized controlled trials are needed to widen its use in patients with advanced CKD and on RRT.