LONG-TERM EFFICIENCY, BIOCOMPATIBILITY, AND CLINICAL SAFETY OF COMBINED SIMULTANEOUS LDL-APHERESIS AND HEMODIALYSIS IN PATIENTS WITH HYPERCHOLESTEROLEMIA AND END-STAGE RENAL-FAILURE

Three hypercholesterolaemic patients on maintenance haemodialysis with angiographically proven coronary artery disease were treated in a onc e-a-week schedule by combined, synchronous lipid apheresis (using hepa rin-induced extracorporeal LDL precipitation) and haemodialysis (HELP/ HD) for 65-104 weeks. Clinical side-effects were few and mostly relate d to high ultrafiltration rates in patients with low compliance regard ing interdialytic fluid restriction. Biocompatibility of the procedure was shown to be good and blood cell losses, leukocyte (elastase relea se) and thrombocyte (beta-thromboglobulin extrusion) as well as comple ment (C3a formation) activation were minimal. Interestingly, most of t he C3a generated in the extracorporeal HELP circuit was immediately re moved again in the precipitate filter. In the pseudosteady-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 protei ns. 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 concen trations amounting to 185 and 220 mg/dl at baseline and were reduced t o 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) w as reduced from 6.4 and 5.1 to about 4.3 in patients with high UF, fro m 6.1 to 3.3 in the patient with low UF: Fibrinogen and Lp(a) were nor malized in all patients. In summary, the combined HELP/HD treatment in hypercholesterolaemic dialysis patients proved to be a safe, effectiv e, and selective procedure for lipoprotein and fibrinogen normalizatio n with excellent biocompatibility and good clinical patient tolerance, providing a tool ready for future atherosclerosis regression studies in ESRD patients.