Lipid reductions by low-density lipoprotein apheresis: a comparison of three systems.
There are currently three established low-density lipoprotein (LDL) apheresis systems: immunoadsorption, heparin-induced extracorporeal LDL precipitation (HELP), and dextran sulfate. We treated the same patient with all three systems and compared the lipid reductions achieved. A total of 135 consecutive treatments were studied, 57 with immunoadsorption, followed by 30 with HELP and 48 with dextran sulfate adsorption. The mean plasma volume (mean +/- SD) treated was 4.9 +/- 0.05, 3.08 +/- 0.091, and 3.39 +/- 0.71 L, respectively. The LDL-cholesterol (LDL-C) reduction was 75.5% +/- 7.4%, 61.6% +/- 5.1%, and 57.1% +/- 12.4%, respectively (P < .001 for immunoadsorption vHELP and dextran sulfate). The mean removal efficiency (mass removed/plasma volume treated) for LDL-C was 1.0 +/- 0.12, 1.42 +/- 0.25, and 1.15 +/- 0.21 g/L, respectively (P < .001 for HELP v immunoadsorption and dextran sulfate). The mean LDL-C plasma concentration before apheresis was 199 +/- 23.9, 201 +/- 25.7, and 186 +/- 28 mg/dL, respectively (P < .001 for dextran sulfate adsorption v immunoadsorption and HELP). Among the three LDL apheresis systems, immunoadsorption caused the greatest percent reduction in LDL-C, while HELP eliminated LDL-C from the plasma most efficiently. Dextran sulfate was similar to HELP in terms of LDL-C reduction, and its removal efficiency was similar to immunoadsorption. Dextran sulfate was also associated with the lowest pretreatment plasma LDL-C concentration.
Jovin
I S
IS
Max-Planck-Institut für physiologische und klinische Forschung, Kerckhoff-Klinik, Bad Nauheim, Germany.
Taborski
U
U
Stehr
A
A
Müller-Berghaus
G
G
D000327:Adsorption; D000328:Adult; D001781:Blood Component Removal / Q000379:methods*; D011232:Chemical Precipitation; D016264:Dextran Sulfate; D006493:Heparin; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood / Q000302:isolation & purification*; D008297:Male
D008077:Lipoproteins, LDL; D006493:Heparin; D016264:Dextran Sulfate