Long-term efficiency, biocompatibility, and clinical safety of combined simultaneous LDL-apheresis and haemodialysis in patients with hypercholesterolaemia and end-stage renal failure

摘要: Three hypercholesterolaemic patients on maintenance haemodialysis with angiographically proven coronary artery disease were treated in a once-a-week schedule by combined, synchronous lipid apheresis (using heparin-induced extracorporeal LDL precipitation) and (HELP/HD) for 65-104 weeks. Clinical side-effects few mostly related to high ultrafiltration rates low compliance regarding interdialytic fluid restriction. Biocompatibility of the procedure was shown be good blood cell losses, leukocyte (elastase release) thrombocyte (beta-thromboglobulin extrusion) as well complement (C3a formation) activation minimal. Interestingly, most C3a generated HELP circuit immediately removed again precipitate filter. In pseudo-steady-state after 3 months regular therapy, acute haematocrit-corrected reduction plasma components session compared pre values about 55% risk factors cholesterol (LDL-C), lipoprotein(a) (Lp(a)), fibrinogen (FIB) recovery HDL-C other proteins. Urea, creatinine, phosphate elimination similar normal haemodialysis. Mean interapheresis one (n = 2) two 1) years treatment crucially dependent upon (UF); thus, UF LDL-C concentrations amounting 185 220 mg/dl at baseline reduced 135 LDL-C, while patient from 231 80 mg/dl. The atherogenic index (LDL-C/HDL-C), 6.4 5.1 4.3 UF, 6.1 3.3 UF.(ABSTRACT TRUNCATED AT 250 WORDS)