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Proprotein convertase subtilisin/kexin type 9 and mortality in patients starting hemodialysis

Towe Strålberg1, Anna Nordenskjöld2, Yang Cao3,4

  • 1School of Medical Sciences, Örebro University, Örebro, Sweden.

European Journal of Clinical Investigation
|March 29, 2019
PubMed

Insights

Proprotein Convertase Subtilsin/Kexin type 9 (PCSK-9) levels predict mortality in patients starting haemodialysis. This U-shaped association highlights PCSK-9 as a novel risk marker for end-stage renal disease patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Biochemistry

Background:

  • Cardiovascular disease is the primary cause of death in end-stage renal disease (ESRD).
  • Traditional lipid markers are poor predictors of cardiovascular risk in ESRD patients.
  • Proprotein Convertase Subtilsin/Kexin type 9 (PCSK-9) is a potential novel cardiovascular risk marker in ESRD, especially with emerging PCSK-9 inhibitor therapies.

Purpose of the Study:

  • To investigate Proprotein Convertase Subtilsin/Kexin type 9 (PCSK-9) as a potential risk marker for mortality in patients initiating haemodialysis.

Main Methods:

  • A cohort study included 265 patients starting haemodialysis (1991-2009) with a 3-year follow-up.
  • Baseline PCSK-9 levels were assessed for association with mortality using Cox proportional hazards and quantile regression models.
  • Analyses were adjusted for potential confounding factors.

Main Results:

  • Baseline PCSK-9 levels showed a significant U-shaped association with all-cause mortality in multivariable analysis.
  • PCSK-9 levels correlated positively with comorbidity score, haemoglobin, and C-reactive protein.
  • Higher PCSK-9 levels were observed in statin users and patients with prior cardiovascular disease.

Conclusions:

  • Proprotein Convertase Subtilsin/Kexin type 9 (PCSK-9) levels are independently associated with all-cause mortality in haemodialysis patients.
  • This study establishes PCSK-9 as a novel mortality risk marker in this population.
  • Findings support PCSK-9's role in cardiovascular risk stratification for ESRD patients.
Abstract

Keywords:
end-stage kidney diseasehemodialysisproprotein convertase subtilisin/kexin type 9

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