Treatment of fibrate-induced rhabdomyolysis with plasma exchange in ESRD.
Hypertriglyceridemia is a common metabolic disorder in patients with chronic renal failure. Fibrate derivatives are often used for lipid lowering in this population with adjusted dosage. However, fibrate-related adverse reaction still occasionally occurs. The authors report a case of end-stage renal disease in a patient who underwent hemodialysis regularly, taking a reduced dosage of bezafibrate (200 mg/d) for refractory hypertriglyceridemia. She did not take any statins, cyclosporine, monoamine oxidase inhibitors, or warfarin concurrently. Rhabdomyolysis was complicated along with an increased serum bezafibrate level. Plasma exchange was performed, which dramatically decreased the level of bezafibrate, and rhabdomyolysis resolved rapidly thereafter. A lower dose of bezafibrate, 200 mg every third day, was prescribed with cautious monitoring of symptoms and laboratory parameters, and better triglyceride control was achieved uneventfully. This is the first report using plasma exchange to remove excessive bezafibrate, a highly protein-bound molecule that is unlikely to be cleared by hemodialysis in an end-stage renal disease patient with serious adverse reaction caused by accumulation of bezafibrate. In contrast to a traditional wait-and-see strategy, plasma exchange seems to be a safe and effective treatment in addition to supportive care for rhabdomyolysis in such clinical scenarios.
Yang
Kai-Chien
KC
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Fang
Cheng-Chung
CC
Su
Ta-Chen
TC
Lee
Yuan-Teh
YT
D001629:Bezafibrate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005921:Glomerulonephritis / Q000150:complications; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications / Q000178:diet therapy / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008875:Middle Aged; D010951:Plasma Exchange; D006435:Renal Dialysis; D012206:Rhabdomyolysis / Q000139:chemically induced / Q000628:therapy*
D000960:Hypolipidemic Agents; D001629:Bezafibrate