Nephrol Dial Transplant (1993) 8: 1350-1358
© 1993 European Renal Association-European Dialysis and Transplant Association
research-article
Long-term efficiency, biocompatibility, and clinical safety of combined simultaneous LDL-apheresis and haemodialysis in patients with hypercholesterolaemia and end-stage renal failure
1Dept. of Nephrology, Medical Clinic I, University of Munich Germany 2Institute of Clinical Chemistry, Klinikum GroBhadern, University of Munich Germany
Correspondence and offprint requests to: Correspondence and offprint requests to: Dr Dr Thomas Bosch, Nephrologische Abteilung, Medizinische IClinik I, Klinikum Großhadern der Universität München, Marchioninistr. 15, D-Munchen 81312, Germany.
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 haemodialysis (HELP/HD) for 65–104 weeks. Clinical side-effects were few and mostly related to high ultrafiltration rates in patients with low compliance regarding interdialytic fluid restriction. Biocompatibility of the procedure was shown to be good and blood cell losses, leukocyte (elastase release) and thrombocyte (ß-thromboglobulin extrusion) as well as complement (C3a formation) activation were minimal. Interestingly, most of the C3a generated in the extracorporeal HELP circuit was immediately removed again in the precipitate filter. In the pseudo-steady-state after 3 months of regular therapy, acute haematocrit-corrected reduction of plasma components after the session compared to pre values were about 55% for the risk factors LDL cholesterol (LDL-C), lipoprotein(a) (Lp(a)), and fibrinogen (FIB) with good recovery of HDL-C and other proteins. Urea, creatinine, and phosphate elimination was similar to normal haemodialysis.
Mean interapheresis values of risk factors after one (n=2) and two (n=1) years of treatment were crucially dependent upon ultrafiltration (UF); thus, in two patients with high UF LDL-C concentrations amounting to 185 and 220mg/dl at baseline and were reduced to about 135mg/dl LDL-C, while in the patient with low UF the reduction was from 231 mg/dl to 80 mg/dl. The atherogenic index (LDL-C/HDL-C) was reduced from 6.4 and 5.1 to about 4.3 in patients with high UF, from 6.1 to 3.3 in the patient with low UF. Fibrinogen and Lp(a) were normalized in all patients.
In summary, the combined HELP/HD treatment in hypercholesterolaemic dialysis patients proved to be a safe, effective, and selective procedure for lipoprotein and fibrinogen normalization with excellent biocompatibility and good clinical patient tolerance, providing a tool ready for future atherosclerosis regression studies in ESRD patients.
Keywords: biocompatibility; complement activation; elastase; HELP; haemodialysis; LDL-apheresis; ß-thromboglobulin