title: Effects of LDL apheresis and vitamin E-modified membrane on carotid atherosclerosis in hemodialyzed patients with arteriosclerosis obliterans.
abstract: BACKGROUND
  Hemodialysis patients manifest accelerated atherosclerosis. Hemodialysis is associated with oxidative stress, which can be partially prevented with the use of a vitamin E-coated dialyzer. Adsorption of low-density lipoprotein (LDL) has been applied in the treatment of arteriosclerosis obliterans (ASO). The aim of the present study was to determine whether the vitamin E-coated dialyzer and/or LDL apheresis affects carotid atherosclerosis in hemodialysis patients with ASO.
  
  
  METHODS
  Thirty hemodialysis patients with ASO were divided into four treatment groups: treatment with conventional cellulose or synthetic membranes (group A, n = 12), treatment with vitamin E-coated membrane (group B, n = 7), treatment with conventional membrane and LDL apheresis (group C, n = 6), and treatment with vitamin E-coated membrane and LDL apheresis (group D, n = 5). Carotid artery intima-media thickness (IMT) and arterial stiffness assessed by pulse wave velocity (PWV), plasma C-reactive protein (CRP) and interleukin (IL)-6 were measured before and 10 weeks after treatment and compared between groups. All values were referred to measurements after LDL apheresis.
  
  
  RESULTS
  IMT and PWV, plasma CRP and IL-6 showed little change in group A throughout the experimental period. These decreased slightly from the baseline value in group B, but the change was not significant. In group C, IMT decreased from 1.12 +/- 0.24 to 1.02 +/- 0.18 mm (p < 0.05), and PWV decreased from 2,266 +/- 380 to 1,968 +/- 342 cm/s (p < 0.05). Plasma CRP and IL-6 concentrations also decreased significantly compared with baseline (p < 0.05). In group D, IMT decreased from 1.18 +/- 0.26 to 0.92 +/- 0.18 mm (p < 0.01), and PWV decreased from 2,284 +/- 390 to 1,786 +/- 284 cm/s (p < 0.01). Plasma CRP and IL-6 levels also decreased significantly compared with baseline (p < 0.01).
  
  
  CONCLUSIONS
  These data suggest that LDL apheresis and the vitamin E-coated membrane dialysis in combination may prevent further progression of atherosclerosis in hemodialysis patients with ASO.
authors.affiliation: Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawagoe
authors.forename: Takaharu
authors.initials: T
authors.lastname: Matsuda
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Keiko
authors.initials: K
authors.lastname: Sekizuka
authors.forename: Isao
authors.initials: I
authors.lastname: Ebihara
authors.forename: Hikaru
authors.initials: H
authors.lastname: Koide
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use*; D001013:Aorta, Thoracic / Q000473:pathology / Q000502:physiology; D001161:Arteriosclerosis / Q000150:complications / Q000517:prevention & control*; D001162:Arteriosclerosis Obliterans / Q000150:complications / Q000517:prevention & control*; D001781:Blood Component Removal; D001794:Blood Pressure / Q000502:physiology; D002097:C-Reactive Protein / Q000378:metabolism; D002339:Carotid Arteries / Q000473:pathology*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008077:Lipoproteins, LDL / Q000097:blood* / Q000302:isolation & purification; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D014810:Vitamin E / Q000627:therapeutic use*
chemical_list: D000924:Anticholesteremic Agents; D000975:Antioxidants; D015850:Interleukin-6; D008077:Lipoproteins, LDL; D008567:Membranes, Artificial; D014810:Vitamin E; D002097:C-Reactive Protein