title: PCSK9 in chronic kidney disease.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) is accompanied by a number of secondary metabolic dysregulations, such as lipid abnormalities, presenting with unique characteristics. Proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors have been introduced as the new era in the management of dyslipidemia with promising results in groups with refractory lipid abnormalities. Increasing number of studies investigate the possible association of PCSK9 levels with kidney function, especially with nephrotic range proteinuria, as well as its role as a prognostic cardiovascular risk marker in CKD. In this review, we discuss the existing evidence for PCSK9 levels in patient groups with nephrotic syndrome, non-dialysis CKD, end-stage renal disease and kidney transplantation.
  
  
  METHODS
  Online research was conducted in MEDLINE database to identify articles investigating PCSK9 in all different aspects of CKD. References from relevant studies were screened for supplementary articles.
  
  
  RESULTS
  Four cross-sectional studies, one secondary analysis, one publication from two independent cohort studies and one multicentre prospective cohort study assessed PCSK9 plasma levels in different subgroups of CKD patients. PCSK9 levels increase in nephrotic syndrome and have a positive correlation with proteinuria. In CKD patients, no correlation was found between PCSK9 levels and estimated GFR. Peritoneal dialysis patients have higher PCSK9 levels compared with hemodialysis and renal transplant patients as well as general population.
  
  
  CONCLUSIONS
  Accumulative evidence focuses on the possible association of PCSK9 levels with kidney function. No data are available for the administration of PCSK9 inhibitors in CKD patients. Further research will optimize knowledge on the role of PCSK9 levels and PCSK9 inhibitors in CKD.
authors.affiliation: Department of Nephrology, Medical School, University of Ioannina, 45 110, Ioannina, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Pavlakou
authors.affiliation: Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Liberopoulos
authors.affiliation: Department of Nephrology, Medical School, University of Ioannina, 45 110, Ioannina, Greece. evangeldou@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Dounousi
authors.affiliation: Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Elisaf
mesh_terms: D050171:Dyslipidemias / Q000097:blood* / Q000150:complications; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy; D016030:Kidney Transplantation; D009404:Nephrotic Syndrome / Q000097:blood* / Q000150:complications / Q000628:therapy; D000071449:Proprotein Convertase 9 / Q000097:blood*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy
chemical_list: C472125:PCSK9 protein, human; D000071449:Proprotein Convertase 9
keywords: Chronic kidney disease; End-stage renal disease; Hemodialysis; Nephrotic syndrome; PCSK9; Peritoneal dialysis; Protein convertase subtilisin/kexin 9; Renal transplantation