Case series showing the safety and changes in lipid profiles of hemodialysis patients with hypertriglyceridemia after pemafibrate administration

Background: Cardiovascular disease is a major cause of morbidity and mortality in patients with chronic kidney disease and end-stage renal disease (ESRD). Dyslipidemia is a key focus of cardiovascular therapy and is characterized by hypertriglyceridemia mainly caused by lipoprotein lipase-mediated metabolism of ApoC-III in patients with ESRD. Pemafibrate, a selective peroxisome proliferator-activated receptor alpha modulator, can be used regardless of renal function and inhibit ApoC-III expression in the liver. Case presentation: We reported the cases of four patients on hemodialysis who met at least 175 mg/dL of triglycerides on the consecutive three tests between September 2022 and November 2022 and took 0.1 mg pemafibrate twice a day from November 2022 to May 2023. They experienced no adverse events after pemafibrate treatment. Pemafibrate significantly reduced triglyceride (TG) (302 ± 72 to 140 ± 50 mg/dL, p = 0.048), total cholesterol (187 ± 34 to 156 ± 48 mg/dL, p = 0.025), and Apo C-III (15.9 ± 8.2 to 12.6 ± 7.1, p = 0.030) levels. Apo A-II levels significantly increased after treatment (27.0 ± 6.1 to 37.1 ± 5.8, p = 0.041). Conclusions: Pemafibrate decreased TG, total cholesterol, and Apo-CIII and increased Apo A-II without adverse events. Further study is needed to examine the favorable effects of pemafibrate on the risk of CVD.