Wolfgang Ramlow1, Eberhard Röseler2, Franz Heigl3, Ralf Spitthöver4, Jens Ringel5, Gerd Schmitz6, Rainer Heinzler7, Nadim Abdul-Rahman8, Frank Leistikow9, Frido Himmelsbach10, Volker Schettler11, Jenny Pham12, Justyna Kozik-Jaromin12. 1. Apherese Centrum Rostock (ACR), Nobelstraße 53, Rostock, Germany. Electronic address: ramlow@apherese.de. 2. Zentrum für Nieren-, Hochdruck und Stoffwechselerkrankungen, Heidering 31, Hannover, Germany. 3. Dres. Heigl, Hettich & Partner Medizinisches Versorgungszentrum, Robert Weixler-Straße 19, Kempten, Germany. 4. Nephrologische Gemeinschaftspraxis Dialysezentrum/Lipidzentrum, Dr. Med. Ralf Spitthöver, Dr. Med. Johann Knee, Dr. Med. Alexandra Gröschel, Hindenburgstraße 27, Essen, Germany. 5. Dialysezentrum Potsdam, Allee Nach Sanssouci 7, Potsdam, Germany. 6. Universitätsklinikum Regensburg Institut für Klinische Chemie und Laboratoriumsmedizin, Franz-Josef-Strauß-Allee 11, Regensburg, Germany. 7. Dr. Med. Detlef Gysan, Dr- Med. Rainer Heinzler, Dr. Med. Erik May Fachärzte für Innere Medizin/Kardiologie, Rolshover Straße 526, Köln, Germany. 8. Dialysezentrum Fachpraxis für Nieren-und Hochdruckkrankheiten & Lipid-Apherese, Liebknechtstraße 36a, Magdeburg, Germany. 9. Apherese- und Nierenzentrum Mannheim, Dornheimer Ring 92, Mannheim, Germany. 10. Apheresezentrum Ingelheim, Carolinenstraße 6, Ingelheim, Germany. 11. Nephrologisches Zentrum Göttingen, An der Lutter 24, Göttingen, Germany. 12. Clinical and Epidemiological Research, Fresenius Medical Care, Else-Kroener-Strasse 1, Bad Homburg, Germany.
Abstract
BACKGROUND: Lipidapheresis techniques are increasingly used to treat drug-resistant hyperlipidemia but few efficacy studies under routine application are available. In this multicenter observational study we investigated direct adsorption of lipoproteins (DALI) and lipoprotein filtration (MONET) for the short and the long-term effects on lipid-lowering effects. METHODS: Data of 122 apheresis patients from 11 centers (DALI: n = 78, MONET: n = 44) were prospectively collected for a period of 2 years. Routine lipid measurements were evaluated (2154 DALI and 1297 MONET sessions). It was investigated whether the relative reduction of LDL-C during apheresis session achieves at least 60%. Also relative reduction of total cholesterol, HDL, triglyceride, and Lp(a) were analyzed. RESULTS: The relative reduction of LDL-C was at least 60%: DALI: 70.62%, 95% CI = [69.34; 71.90] and MONET: 64.12%, 95% CI = [60.79; 67.46]. Also triglycerides were reduced with both systems: DALI 38.63%, 95% CI = [33.95; 43.30] vs. MONET 57.68%, 95% CI = [51.91; 63.45]. Relative reductions of total cholesterol were in the range of 50% (DALI 95% CI = [46.49; 49.65] MONET 95% CI = [48.93; 55.26]) and of Lp(a) in the range of 65% (DALI 95% CI = [61.92; 65.83] MONET 95% CI = [63.71; 70.30]. HDL reduction was: DALI 15.01%, 95% CI = [13.22; 16.79] and MONET 22.59%, 95% CI = [19.33; 25.84]. For both devices treated patient plasma/blood volume and in case of DALI the use of the larger adsorber configurations (DALI 1000 and DALI 1250) were independent positive predictors of the relative reduction of LDL-C and of Lp(a). CONCLUSIONS: Both systems effectively improved lipid profile and reduced atherogenic lipids. The results point to the importance of the individualized application of these valuable therapies to achieve clinical targets.
BACKGROUND: Lipidapheresis techniques are increasingly used to treat drug-resistant hyperlipidemia but few efficacy studies under routine application are available. In this multicenter observational study we investigated direct adsorption of lipoproteins (DALI) and lipoprotein filtration (MONET) for the short and the long-term effects on lipid-lowering effects. METHODS: Data of 122 apheresis patients from 11 centers (DALI: n = 78, MONET: n = 44) were prospectively collected for a period of 2 years. Routine lipid measurements were evaluated (2154 DALI and 1297 MONET sessions). It was investigated whether the relative reduction of LDL-C during apheresis session achieves at least 60%. Also relative reduction of total cholesterol, HDL, triglyceride, and Lp(a) were analyzed. RESULTS: The relative reduction of LDL-C was at least 60%: DALI: 70.62%, 95% CI = [69.34; 71.90] and MONET: 64.12%, 95% CI = [60.79; 67.46]. Also triglycerides were reduced with both systems: DALI 38.63%, 95% CI = [33.95; 43.30] vs. MONET 57.68%, 95% CI = [51.91; 63.45]. Relative reductions of total cholesterol were in the range of 50% (DALI 95% CI = [46.49; 49.65] MONET 95% CI = [48.93; 55.26]) and of Lp(a) in the range of 65% (DALI 95% CI = [61.92; 65.83] MONET 95% CI = [63.71; 70.30]. HDL reduction was: DALI 15.01%, 95% CI = [13.22; 16.79] and MONET 22.59%, 95% CI = [19.33; 25.84]. For both devices treated patient plasma/blood volume and in case of DALI the use of the larger adsorber configurations (DALI 1000 and DALI 1250) were independent positive predictors of the relative reduction of LDL-C and of Lp(a). CONCLUSIONS: Both systems effectively improved lipid profile and reduced atherogenic lipids. The results point to the importance of the individualized application of these valuable therapies to achieve clinical targets.
Authors: Martina Gaggl; Constantin Aschauer; Christof Aigner; Gregor Bond; Andreas Vychytil; Robert Strassl; Ludwig Wagner; Gere Sunder-Plassmann; Alice Schmidt Journal: Front Immunol Date: 2022-09-26 Impact factor: 8.786