Combined Treatment With Lipoprotein Apheresis and Hemodialysis in Patients With Severe Cardiovascular Disease, High Lipoprotein(a) and End Stage Renal Disease

Abstract

Elevated Lipoprotein(a) (Lp(a)) is a known independent cardiovascular risk factor. Lp(a) Lipoprotein Apheresis (LA) substantially reduces the number of cardiovascular events. The effect of LA treatment in hemodialysis (HD) patients remains unknown. Retrospective analysis of nine patients undergoing LA and HD. Cardiovascular risk factors and the efficacy of treatment were assessed. Adverse cardiac or vascular events (ACVE) were recorded. Median (range) years on HD were 4.2 (1.5 to 23.6) years and median years on LA were 4.0 (1.6 to 12.4) years. Before initiation of LA, median (range) Lp(a) level was 242.67 (164.0 to 400.10) nmol/L and mean LDL-C level (±SD) 2.49 (±1.14) mmol/L. Under treatment, mean acute reduction rates, comparing concentrations before and after LA sessions, were 64.15 (±5.45)% for Lp(a) and 57.26 (±7.93)% for LDL-C. Before initiation of LA, 14 ACVE occurred; after initiation, only 6 (57.2% reduction rate). In this small cohort, LA appears to be effective in reducing ACVE in patients on HD with elevated Lp(a) levels. Further studies are needed to evaluate the effect of LA on cardiovascular outcomes in dialysis patients.