Use-of-alirocumab-for-the-secondary-prevention-of-cardiovascular-disease-in-a-patient-with-end-stage-renal-disease-on-hemodialysis

Abstract

Introduction: Cardiovascular diseases (CVDs) are quite prevalent globally, with atherosclerotic being a predominant CVD in Asia. Well-controlled low-density lipoprotein cholesterol (LDL-C) level is crucial in both primary and secondary prevention of these conditions, particularly in patients with chronic kidney disease (CKD). Lipid management in this setting is a major concern for physicians and patients. Here, we report the case of a man with previous hypertension, type 2 diabetes mellitus, dyslipidemia, peripheral artery disease, CKD, heart failure, and coronary artery disease post multiple stent implantations. He was initiated on rosuvastatin treatment, during which he developed rhabdomyolysis, and subsequently received regular hemodialysis. Since the patient was at a very high risk of cardiovascular events and adverse drug reactions, treatment with alirocumab (a proprotein convertase subtilisin / kexin type 9 inhibitor) was initiated for further controlling LDL-C level. Although there is a lack of evidence on the use of alirocumab in patients on hemodialysis, the drug demonstrated a favorable efficacy and safety profile in our patient.