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Long-term plasma exchange via Cimino fistula in patients with hypercholesterolemia
J Passfall1, F Keller, H R Arntz
1Klinikum Steglitz, Medizinische Klinik, Berlin.
Insights
Long-term plasma exchange effectively reduced cholesterol in familial hypercholesterolemia patients. This treatment lowered LDL cholesterol, improving cardiovascular health markers.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder causing extremely high LDL cholesterol levels.
- Elevated LDL cholesterol significantly increases the risk of premature cardiovascular disease.
Purpose of the Study:
- To evaluate the efficacy of long-term plasma exchange in managing severe familial hypercholesterolemia.
- To assess the impact of plasma exchange on lipid profiles and clinical outcomes in FH patients.
Main Methods:
- Two patients with FH underwent long-term plasma exchange therapy.
- An arteriovenous Cimino shunt and unselective membrane separation were utilized for plasma exchange.
- Lipid levels (total cholesterol, LDL, HDL) were monitored regularly.
Main Results:
- Plasma exchange reduced cholesterol to approximately 40% of peak levels per procedure.
- Mean peak cholesterol levels decreased from 406 mg/dL to 322 mg/dL.
- LDL cholesterol decreased from 338 mg/dL to 265 mg/dL, while HDL cholesterol remained stable.
Conclusions:
- Long-term plasma exchange is a viable treatment option for reducing cholesterol in FH patients.
- The procedure demonstrated significant reductions in LDL cholesterol, potentially mitigating cardiovascular risk.
- Clinical improvement, including enhanced electrocardiographic stress test results, was observed in one patient.
Abstract:
Two patients with familial hypercholesterolemia were treated by long-term plasma exchange via an arteriovenous Cimino shunt using unselective membrane separation. Cholesterol was lowered to 40 percent (+/-3) of peak levels by each procedure. Sieving coefficient was 0.76 (+/-0.12). With a mean exchange interval of 11 days (+/-2), the peak cholesterol levels decreased from 406 mg per dl (+/-28) to 322 mg per dl (+/-27), the LDL fraction from 338 mg per dl (+/-9) to 265 mg per dl (+/-25) whereas the HDL fraction remained unchanged at 28 mg per dl (+/-4). Electrocardiographic stress testing improved in the first patient after treatment for 12 months.