背景:治疗慢性肾病(CKD)患者的高甘油三酯血症非常重要。匹马贝特,一种新型选择性过氧化物酶体增殖物激活受体-α调节剂,对肝肾功能的毒性作用小于其他贝特类药物,最近已被批准用于治疗估计肾小球滤过率(eGFR)低于30mL/min/1.73m2的患者。然而,对重度肾功能损害患者使用培美贝贝特的疗效和安全性尚未确定.
方法:这种单中心,回顾性观察性研究包括12例CKD和高甘油三酯血症的门诊患者,在2021年12月至2023年5月期间新开始接受低剂量培贝贝特(0.1mg/天)治疗的患者,其基线时eGFRs小于30mL/min/1.73m2.在治疗前和治疗后12周收集血样。
结果:治疗12周后,血清甘油三酯水平显著下降,而高密度脂蛋白胆固醇水平显著升高.血清丙氨酸转氨酶,碱性磷酸酶,γ-谷氨酰转肽酶,尿酸水平也显著下降,没有恶化的eGFR和血清肌酐水平。在亚组分析中,无论基线时他汀类药物的使用和CKD分期,临床参数的变化均无显著差异.
结论:对严重肾功能损害患者给予低剂量的匹马贝特可显著改善甘油三酯,高密度脂蛋白胆固醇,和血清尿酸水平,和肝功能,无不良事件。
BACKGROUND: The management of hypertriglyceridemia in patients with chronic kidney disease (CKD) is important.
Pemafibrate, a novel selective peroxisome proliferator-activated receptor-alpha modulator with less toxic effects on liver and kidney function than those of other fibrates, has recently been approved for the treatment of patients with an estimated glomerular filtration rate (eGFR) lower than 30 mL/min/1.73 m2. However, the efficacy and safety of
pemafibrate in patients with severe renal impairment have not yet been established.
METHODS: This single-center, retrospective observational study included 12 outpatients with CKD and hypertriglyceridemia, who were newly started on low-dose
pemafibrate (0.1 mg/day) treatment between December 2021 and May 2023 and whose eGFRs were less than 30 mL/min/1.73 m2 at baseline. Blood samples were collected before and at 12 weeks after
pemafibrate treatment.
RESULTS: After 12 weeks of treatment, the serum triglyceride level was significantly decreased, whereas the high-density lipoprotein cholesterol level was significantly increased. The serum alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, and uric acid levels were also significantly decreased, without worsening of the eGFR and serum creatinine levels. In the subgroup analysis, there were no significant differences in the changes in clinical parameters regardless of statin use and CKD stage at baseline.
CONCLUSIONS: Low-dose
pemafibrate administration in patients with severe renal impairment resulted in significant improvements in triglyceride, high-density lipoprotein cholesterol, and serum uric acid levels, and liver function, without adverse events.