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.