Severe hypercholesterolemia effectively lowered with hemodialysis: a case report

Abstract

Background: Hypercholesterolemia is a known risk factor for cardiovascular morbidity and mortality. Reviews of current literature suggest a linear correlation between the level of low density lipoprotein cholesterol (LDL-C) and the risk of cardiovascular disease. There are no guidelines that specifically address the management of severe hypercholesterolemia related to an underlying pathology or that observed in familial hypercholesterolemia.

Case report: A 49-year-old African American man presented with painless jaundice, generalized itching, and a 30 lbs weight loss in three months. Multiple xanthoma like lesions were noted on his arms. His hepatic panel was normal. His levels of total cholesterol and low density lipoprotein cholesterol were elevated to more than 1,000 mg/dl each. Serum alkaline phosphatase, total bilirubin, and direct bilirubin were elevated at 1,715 U/L, 7.2 mg/dl, and 4.5 mg/dl, respectively. The level of high density lipoprotein cholesterol was undetectable. Anti-mitochondrial antibodies and hepatitis serologies were negative. There was no clinical evidence to suggest familial hypercholesterolemia. Imaging studies of his abdomen were negative for hepatic biliary dilation. A liver biopsy revealed stage 3 fibrosis. His severe hypercholesterolemia was treated with ezetimibe, since statin was contraindicated in this case. In addition to liver fibrosis, the patient developed renal failure that required intermittent hemodialysis. His LDL cholesterol (LDL-C) and total cholesterol (TC) levels trended down with an absolute reduction of 70%.

Conclusion: The treatment of patients with severe hypercholesterolemia should aim at reducing the LDL-C level. We suggest that hemodialysis contributed to the significant reduction of LDL cholesterol level in our case; and therefore might be a potential tool for reducing high LDL-C levels in these patients.