Efficacy of low-density lipoprotein apheresis in patients with peripheral arterial occlusive disease undergoing hemodialysis treatment.
BACKGROUND
Low-density lipoprotein (LDL) apheresis is effective in the treatment of peripheral arterial occlusive disease (PAOD). In the present study, we attempted to determine whether LDL apheresis is effective even for PAOD patients undergoing hemodialysis, who tend to be refractory to any treatment, and if so, to determine the mechanism of its efficacy.


METHODS
Serum levels of lipids and vascular growth factors, leg symptom, and endothelium-dependent vasodilation were investigated before and after 10 sessions of LDL apheresis in 11 PAOD patients undergoing hemodialysis.


RESULTS
Serum levels of total cholesterol, LDL cholesterol, and triglyceride exhibited drastic reduction, which completely disappeared 4 weeks after the final apheresis. Resting leg pain was improved in 6 cases even 4 weeks after final apheresis. Endothelium-dependent vasodilation was significantly increased 4 weeks after final apheresis (1.6 +/- 0.6 to 4.7 +/- 1.0%, p < 0.05). Levels of vascular growth factors, hepatocyte growth factor and vascular endothelial growth factor were not changed during treatment.


CONCLUSIONS
These findings suggested that LDL apheresis is effective even in PAOD patients undergoing hemodialysis. Our findings suggest that its mechanisms of efficacy include improvement of vascular endothelial dysfunction, in addition to drastic but acute reduction of lipid levels. Since PAOD patients undergoing hemodialysis tend to be resistant to any treatment and are at high risk for lower-extremity amputation, LDL apheresis could be a useful strategy for treatment of them.
Morimoto
Satoshi
S
Department of Internal Medicine, Ohmihachiman City Hospital, Osaka, Japan. morimots@hirakata.kmu.ac.jp
Yano
Yutaka
Y
Maki
Kei
K
Sawada
Katsunori
K
Iwasaka
Toshiji
T
D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D001781:Blood Component Removal; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D042783:Endothelial Cells; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010146:Pain; D006435:Renal Dialysis; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D042442:Vascular Endothelial Growth Factors / Q000096:biosynthesis / Q000097:blood; D014664:Vasodilation
D008078:Cholesterol, LDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; D042442:Vascular Endothelial Growth Factors; D002784:Cholesterol