Efficacy of low-density lipoprotein apheresis combined with corticosteroids for cholesterol crystal embolism.
BACKGROUND
Corticosteroids have been widely used in patients with cholesterol crystal embolism (CCE) and low-density lipoprotein apheresis (LDL-A) was reported to reduce the risk of end-stage renal disease in patients with CCE. This study was designed to evaluate the renoprotective effects of LDL-A in combination with corticosteroids in patients with CCE.


METHODS
Thirty-five patients with CCE who, between 2008 and 2013, had shown renal deterioration after vascular interventions were retrospectively evaluated. All patients received corticosteroids; of these, 24 also received LDL-A and 11 did not, designated LDL-A and control groups, respectively. Differences in eGFR (ΔeGFR), 3 months and 1 year after CCE diagnosis, were compared in the two groups.


RESULTS
The median estimated glomerular filtration rate (eGFR) in all patients was 38.9 [interquartile range (IQR) 31.9-49.4] ml/min/1.73 m2at baseline (before vascular intervention). At diagnosis, it was 14.4 (IQR 11.3-21.8) ml/min/1.73 m2. The initial corticosteroid dose was 0.34 ± 0.10 mg/kg/day. The mean number of LDL-A treatment sessions in the LDL-A group was 4.3 ± 1.8. eGFR was increased significantly after LDL-A treatments, from 15.0 (IQR 12.3-20.1) to 19.6 (IQR 14.3-23.6) ml/min/1.73 m2(P < 0.05). ΔeGFR tended to be higher in the LDL-A than in the control group at 3 months [median 6.5 (IQR 5.1-9.3) vs. 2.6 (IQR -0.6 to 6.3) ml/min/1.73 m2, P = 0.095] and was significantly higher at 1 year [median 7.5 (IQR 5.4-8.7) vs. 2.2 (IQR -3.8 to 5.1) ml/min/1.73 m2, P = 0.019].


CONCLUSIONS
LDL-A plus corticosteroids may restore deteriorated renal function better than corticosteroids alone in patients with CCE.
Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, 3-16-1 Tsutsumimachi, Aoba-ku, Sendai, Miyagi, 981-8501, Japan. ishiyama-katsuya@sendai.jcho.go.jp.
Katsuya
K
Ishiyama
Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, 3-16-1 Tsutsumimachi, Aoba-ku, Sendai, Miyagi, 981-8501, Japan.
Toshinobu
T
Sato
Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan.
Takuhiro
T
Yamaguchi
Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, 3-16-1 Tsutsumimachi, Aoba-ku, Sendai, Miyagi, 981-8501, Japan.
Yoshio
Y
Taguma
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001781:Blood Component Removal / Q000379:methods*; D008078:Cholesterol, LDL / Q000097:blood*; D003131:Combined Modality Therapy; D003460:Crystallization; D017700:Embolism, Cholesterol / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D008078:Cholesterol, LDL
Atherosclerosis; Cholesterol crystal embolism; Low-density lipoprotein apheresis