Abstract: Objective  To analyze the relationship between plasma proprotein convertase subtilisin/kexin 9 (PCSK9) level and cardiovascular disease (CVD) death in maintenance hemodialysis (MHD) patients.  Methods A total of 84 MHD patients treated in Lianyungang First People's Hospital from Jan 2019 to Dec 2020 were recruited as the research subjects. A total of 84 healthy volunteers from health examinations in the same period were recruited as the healthy control group. The relationship between plasma PCSK9 level and clinical and laboratory indexes was analyzed by Spearson correlation. The risk factors for CVD death in MHD patients were analyzed by multivariate logistic regression. The predictive value of plasma PCSK9 level for CVD death in MHD patients was assessed by ROC curve.  Results  The plasma PCSK9 level was significantly higher in MHD group than in healthy control group  (t=8.775, P＜0.001). In the MHD patients, plasma PCSK9 level was significantly lower in the survival patients than in the patients died of CVD (t=7.638, P＜0.001). Plasma PCSK9 level was negatively correlated with Kt/V, albumin and high-density lipoprotein cholesterol (r=-0.421, -0.402 and -0.387 respectively; P<0.001, <0.001 and=0.001 respectively), and was positively correlated with low-density lipoprotein cholesterol, total cholesterol, triglyceride and leukocyte count        (r=0.355, 0.395, 0.324 and 0.399 respectively; P=0.006, <0.001, =0.011 and <0.001 respectively). High plasma PCSK9 level was the independent risk factors for CVD death in MHD patients (OR=2.054, 95% CI: 1.421～6.293, P=0.002). The AUC of plasma PCSK9 level for predicting CVD death in MHD patients was 0.822 (95% CI: 0.711～0.904) with the sensitivity of 79.26% and the specificity of 72.55% when the cut-off value was set at 255.65ng/mL  Conclusion  Plasma PCSK9 level increases significantly in MHD patients, especially in those died of CVD. Plasma PCSK9 level is an independent risk factor for CVD death in MHD patients, and also has the predictive value for CVD death in MHD patients.

Key words: Maintenance hemodialysis, Proprotein convertase subtilisin/kexin 9, Cardiovascular disease, Relevance, Predictive value