Retrospective comparison of 5 different methods for long-term LDL-apheresis in 20 patients between 1986 and 2001.
OBJECTIVE
To compare long-term efficacy and biocompatibility of the 5 most commonly applied LDL-apheresis techniques using a specifically modified calculation method of the area under the curve (AUC) for laboratory parameters.


METHODS
Retrospective long-term analysis of 20 patients with homozygous or severe heterozygous familial hypercholesterolemia.


METHODS
The following 5 extra-corporeal LDL-apheresis methods were compared: IMAL (Immuno Adsorption of Lipoproteins), DSA (Dextran Sulphate Adsorption), HELP (Heparin Induced Extra-corporeal LDL Precipitation), DALI (Direct Adsorption of Lipoproteins), MDF (Membrane Differential Filtration).


METHODS
AUC derived plasma concentrations (C(AUC)) of lipoproteins between two apheresis procedures and their long-term course. Comparison of biocompatibility and efficacy concerning the LDL-C target of < 2.6 mmol/L of 5 apheresis techniques. Progression of atherosclerosis in patients with severe hypercholesterolemia.


RESULTS
The means of AUC derived average plasma concentrations (C(AUC)) of all treatment intervals were for LDL-C and the LDL/HDL ratio as follows: IMAL (5.59 mmol/L; ratio 4.1), DSA (3.03 mmol/L; ratio 2.0), HELP (4.06 mmol/L; ratio 2.2), DALI (3.83 mmol/L; ratio 3.3), MDF (3.26 mmol/L; ratio 3.2). Coronary heart disease and cardiac events (myocardial infarction, PTCA/ stent implantation, CABG) progressed in only 2 patients whereas atherosclerosis manifestations (sclerosis abdominal aorta, carotid artery stenosis, peripheral vascular disease) worsened in 13 patients. Mean ergometric capacity improved from 112 to 118 Watt.


CONCLUSIONS
All 5 apheresis methods (IMAL, DSA, HELP, DALI, MDF) proved to be safe and suitable for long-term treatment in patients with severe hypercholesterolemia. The introduction of the C(AUC) revealed that the target of LDL-C < 2.6 mmol/L was not achieved with regard to the time averaged concentration (C(AUC)).
Krebs
A
A
Division of Nephrology, Medical Faculty, University of Ulm, Germany.
Krebs
K
K
Keller
F
F
D000328:Adult; D019540:Area Under Curve; D001781:Blood Component Removal / Q000379:methods*; D008076:Cholesterol, HDL / Q000032:analysis / Q000378:metabolism*; D008078:Cholesterol, LDL / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL