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

Abstract

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. 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), 3months and 1year after CCE diagnosis, were compared in the two groups. The median estimated glomerular filtration rate (eGFR) in all patients was 38.9 [interquartile range (IQR) 31.9-49.4] ml/min/1.73m2 at baseline (before vascular intervention). At diagnosis, it was 14.4 (IQR 11.3-21.8) ml/min/1.73m2. The initial corticosteroid dose was 0.34±0.10mg/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/1.73m2 (P<0.05). ΔeGFR tended to be higher in the LDL-A than in the control group at 3months [median 6.5 (IQR 5.1-9.3) vs. 2.6 (IQR -0.6 to 6.3) ml/min/1.73m2, P=0.095] and was significantly higher at 1year [median 7.5 (IQR 5.4-8.7) vs. 2.2 (IQR -3.8 to 5.1) ml/min/1.73m2, P=0.019]. LDL-A plus corticosteroids may restore deteriorated renal function better than corticosteroids alone in patients with CCE.