Selective removal of triglyceride-rich lipoproteins by plasmapheresis in diabetic patients with severe hypertriglyceridemia.
Two diabetic patients with marked intractable hypertriglyceridemia under treatment with hemodialysis for chronic renal failure were treated by either an apolipoprotein B-dependent removal of lipoproteins using dextran sulfate cellulose column plasmapheresis or a size-dependent removal of lipoproteins using hollow-fiber filtration plasmapheresis. In one patient, a column packed with hollow fibers was used as a plasma separator and a dextran sulfate cellulose column as an adsorbent. In another patient, because the hollow-fiber column did not separate plasma from whole blood, a centrifuge-type blood cell separator was used for the plasma separation. The amounts of plasma cholesterol, triglycerides, and phospholipids removed by plasmapheresis were 30%, 33%, and 30%, respectively, when the combination of a hollow-fiber column and a dextran sulfate cellulose column was used. Corresponding values were 31%, 29%, and 27%, respectively, when the combination of the centrifuge-type blood cell separator and the hollow-fiber column was used. The efficiency of lipid removal was almost the same with both techniques. As for plasma separation, the centrifuge-type blood cell separator was more efficient than the hollow-fiber column. Some losses of albumin and platelets were observed when combination plasmapheresis using the centrifuge-type blood cell separator and the hollow-fiber column was performed. In conclusion, we prefer the centrifuge-type blood cell separator to the hollow-fiber column for plasma separation of marked hypertriglyceridemia. The second filter must be chosen for each patient according to the size of the lipoproteins.
Department of Internal Medicine, Tokyo Teishin Hospital, Japan.
H
H
Ito
C
C
Naito
H
H
Hayashi
M
M
Kawamura
S
S
Miyazaki
D000328:Adult; D001053:Apolipoproteins / Q000097:blood; D002784:Cholesterol / Q000097:blood; D003928:Diabetic Nephropathies / Q000150:complications*; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000628:therapy; D008074:Lipoproteins / Q000097:blood*; D008875:Middle Aged; D010743:Phospholipids / Q000097:blood; D010956:Plasmapheresis / Q000379:methods; D006435:Renal Dialysis; D014280:Triglycerides / Q000097:blood*
D001053:Apolipoproteins; D008074:Lipoproteins; D010743:Phospholipids; D014280:Triglycerides; D002784:Cholesterol