Related Experiment Videos
Contact activation in low-density lipoprotein apheresis systems
Detlef H Krieter1, Jörn Steinke, Markus Kerkhoff
1Department of Nephrology, University of Würzburg, Würzburg, Germany. krieter_d@klinik.uni-wuerzburg.de
Artificial Organs
|January 13, 2005
Summary
LDL apheresis using dextran sulfate cellulose (DSC) and modified polyacrylate gels (DALI) systems activates the kallikrein-kinin system, unlike the HELP system. ACE inhibitors are contraindicated with DSC and DALI, but suitable for HELP.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Biochemistry
Background:
- Anaphylactoid reactions linked to ACE inhibitors and dialysis membranes suggest contact activation is a concern.
- Negatively charged surfaces in LDL apheresis systems may trigger contact activation.
- Investigated contact activation during LDL apheresis using HELP, DSC, and DALI systems.
Purpose of the Study:
- To investigate contact activation during LDL apheresis with three different systems.
- To assess the kallikrein-kinin system activation in patients undergoing LDL apheresis.
Main Methods:
- 24 patients on regular LDL apheresis treatment were studied.
- Bradykinin, prekallikrein, and HMW kininogen levels were measured during apheresis.
- Measurements were taken at various points within the apheresis systems.
Main Results:
- DSC and DALI systems caused significant bradykinin release and depletion of prekallikrein and HMW kininogen.
- Elevated bradykinin levels in DSC and DALI systems exceeded degradation capacity.
- The HELP system did not activate the kallikrein-kinin system.
Conclusions:
- ACE inhibitors are contraindicated with DSC and DALI LDL apheresis systems due to bradykinin release.
- The HELP system is a suitable alternative for patients requiring ACE inhibitors as it avoids kallikrein-kinin system activation.