title: PCSK9 in diabetic kidney disease.
abstract: BACKGROUND
  Chronic Kidney Disease (CKD) and, specifically, diabetic kidney disease (DKD)+, is among the fastest increasing causes of death worldwide. A better understanding of the factors contributing to the high mortality may help design novel monitoring and therapeutic approaches, since protection offered by statins in CKD patients is not satisfactory. Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) promotes hypercholesterolemia and may be targeted therapeutically. Adding anti-PCSK9 agents to standard lipid lowering therapy further reduces the incidence of cardiovascular events.
  
  
  METHODS
  We studied plasma PCSK9 in a cross-sectional study of 134 diabetic kidney disease patients with estimated glomerular filtration rate (eGFR) categories G1-G4 and albuminuria categories A1-A3, in order to identify factors influencing plasma PCSK9 in this population.
  
  
  RESULTS
  Mean±SD plasma PCSK9 levels were 309.8±113.9 ng/ml. Plasma PCSK9 was not influenced by eGFR or albuminuria, but was higher in patients on lipid lowering therapy. In univariate analysis, plasma PCSK9 showed a significant positive correlation with serum total iron binding capacity, vitamin E, plasma renin and phosphaturia, and there was a trend towards a positive correlation with total serum cholesterol. In multivariate models, only therapy with fibrate and statin, and renin remained independently correlated with plasma PCSK9. However, multivariate models explained very little of the PCSK9 variability.
  
  
  CONCLUSIONS
  In DKD, therapy with lipid lowering drugs and specially the fibrate/statin combination were independently associated with higher PCSK9 levels. The biomarker potential of PCSK9 levels to identify DKD patients that may benefit from anti-PCSK9 strategies should be studied.
authors.affiliation: IIS-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.|Fundación Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain.|REDINREN, Madrid, Spain.
authors.forename: Usama
authors.initials: U
authors.lastname: Elewa
authors.affiliation: IIS-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.|Fundación Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain.|REDINREN, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Fernández-Fernández
authors.affiliation: IIS-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Mahillo-Fernández
authors.affiliation: IIS-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.|Fundación Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain.|REDINREN, Madrid, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Martin-Cleary
authors.affiliation: IIS-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.|Fundación Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain.|REDINREN, Madrid, Spain.
authors.forename: Ana Belen
authors.initials: AB
authors.lastname: Sanz
authors.affiliation: IIS-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.|Fundación Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain.|REDINREN, Madrid, Spain.
authors.forename: Maria D
authors.initials: MD
authors.lastname: Sanchez-Niño
authors.affiliation: IIS-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.|Fundación Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain.|REDINREN, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ortiz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D005260:Female; D058607:Fibric Acids / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000071449:Proprotein Convertase 9 / Q000097:blood*
chemical_list: D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol; C472125:PCSK9 protein, human; D000071449:Proprotein Convertase 9
keywords: Cardiovascular risk; PCSK9; chronic kidney disease; diabetes mellitus; fibrate; statin