Efficacy of low-density lipoprotein apheresis combined with corticosteroids for cholesterol crystal embolism

Katsuya Ishiyama, Toshinobu Sato, Takuhiro Yamaguchi, Yoshio Taguma

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

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 m2 at 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.

Original languageEnglish
Pages (from-to)228-235
Number of pages8
JournalClinical and experimental nephrology
Volume21
Issue number2
DOIs
Publication statusPublished - 2017 Apr 1
Externally publishedYes

Keywords

  • Atherosclerosis
  • Cholesterol crystal embolism
  • Low-density lipoprotein apheresis

ASJC Scopus subject areas

  • Physiology
  • Nephrology
  • Physiology (medical)

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