Treatment of fibrate-induced rhabdomyolysis with plasma exchange in ESRD
Journal
American Journal of Kidney Diseases
Journal Volume
45
Journal Issue
3
Pages
e57-e60
Date Issued
2005
Author(s)
Abstract
Hypertriglyceridemia is a common metabolic disorder in patients with chronic renal failure. Fibrate derivatives are often used for lipid lowering in this population with adjusted dosage. However, fibrate-related adverse reaction still occasionally occurs. The authors report a case of end-stage renal disease in a patient who underwent hemodialysis regularly, taking a reduced dosage of bezafibrate (200 mg/d) for refractory hypertriglyceridemia. She did not take any statins, cyclosporine, monoamine oxidase inhibitors, or warfarin concurrently. Rhabdomyolysis was complicated along with an increased serum bezafibrate level. Plasma exchange was performed, which dramatically decreased the level of bezafibrate, and rhabdomyolysis resolved rapidly thereafter. A lower dose of bezafibrate, 200 mg every third day, was prescribed with cautious monitoring of symptoms and laboratory parameters, and better triglyceride control was achieved uneventfully. This is the first report using plasma exchange to remove excessive bezafibrate, a highly protein-bound molecule that is unlikely to be cleared by hemodialysis in an end-stage renal disease patient with serious adverse reaction caused by accumulation of bezafibrate. In contrast to a traditional wait-and-see strategy, plasma exchange seems to be a safe and effective treatment in addition to supportive care for rhabdomyolysis in such clinical scenarios. ? 2005 by the National Kidney Foundation, Inc.
SDGs
Other Subjects
bezafibrate; cyclosporin; fibric acid derivative; hydroxymethylglutaryl coenzyme A reductase inhibitor; monoamine oxidase inhibitor; triacylglycerol; warfarin; adult; article; case report; drug blood level; female; hemodialysis; human; hypertriglyceridemia; kidney failure; laboratory; parameter; plasmapheresis; rhabdomyolysis; safety
Type
journal article