How to optimize lipoprotein apheresis treatment--a second look
Related Experiment Video
Updated: May 14, 2026
Isolation and Analysis of Plasma Lipoproteins by Ultracentrifugation
Published on: January 28, 2021
V Schettler1, C L Neumann, G C Hagenah
1Nephrologisches Zentrum Göttingen GbR, Göttingen, Germany. v.schettler@nz-goe.de
Insights
Lipoprotein apheresis (LA) effectively lowers LDL-C and Lp(a), but optimal treatment volumes are often miscalculated. Increasing volumes by 1.3-fold and assessing individual capacity may improve LA effectiveness for cardiovascular disease patients.
Area of Science:
- Cardiovascular Medicine
- Medical Technology
Background:
- Lipoprotein apheresis (LA) is a vital treatment for hypercholesterolemic patients with cardiovascular disease (CHD) unresponsive to diet and medication.
- Standard formulas for calculating plasma volume (PV) and blood volume (BV) are used to determine LA treatment volumes for lowering LDL-cholesterol (LDL-C) and lipoprotein (a) (Lp(a)).
- However, not all patients achieve target LDL-C (<70 mg/dl) and Lp(a) (<30 mg/dl) levels with current LA protocols, necessitating optimization strategies.
Purpose of the Study:
- To investigate methods for increasing the effectiveness of lipoprotein apheresis (LA) in achieving target lipid concentrations.
- To compare actual treated volumes with calculated plasma volume (PV) and blood volume (BV) in patients undergoing LA.
- To determine the capacity threshold of LA procedures to optimize treatment capacity independent of calculated volumes.
Main Methods:
- Patients undergoing regular LA had their actual treated volumes compared to calculated PV and BV over time.
- Treatment volumes were stepwise increased to achieve target cholesterol concentrations.
- During LA procedures, cholesterol, triglycerides, LDL-C, HDL-C, and Lp(a) were measured every 20 minutes and related to hematocrit to account for dilution effects.
Main Results:
- Actual treated volumes in LA patients were significantly different from calculated volumes: 28 ± 18% for PV (n=7) and 28 ± 20% for BV (n=6).
- A mean increase of 1.3-fold in treated volumes compared to calculated volumes was necessary to achieve target cholesterol levels in most LA treatments.
- Only one patient (1/13) experienced ineffective long treatment times, and no procedures failed due to exhausted capacity.
Conclusions:
- Lipoprotein apheresis (LA) is highly effective for lowering LDL-C and Lp(a), but calculated volumes (PV, BV) can be error-prone.
- Increasing calculated LA volumes by approximately 1.3-fold is a potential first step to optimize individual treatment.
- Determining individual capacity thresholds can further refine LA treatment volumes and prevent procedure exhaustion, though further data are needed.
Background:
Lipoprotein apheresis (LA) is used in hypercholesterolemic patients suffering from cardiovascular disease (CHD) if a modified diet and lipid-lowering drug regimens had failed. During the first LA treatments LDL-cholesterol (LDL-C) and lipoprotein (a) (Lp(a)) can be decreased very effectively when using generally accepted formulas for calculating plasma (PV) (e.g. Pearson) or blood volumes (BV) as a basis for calculating treatment volume (e.g. Nadler). With respect to LDL-C and Lp(a) levels after LA treatment not all treated patients on steady state with apheresis treatment procedures may achieve the desired target concentrations for LDL-C (<70 mg/dl) and Lp(a) (<30 mg/dl). Are there further ways to increase the effectiveness of LA?
Methods:
Over months or years of LA the treated volumes were stepwise increased in patients to achieve target cholesterol concentrations but not sufficiently in all cases. Therefore the patients' actual LA treatment volumes were compared to the calculated PV or BV. To possibly optimize the treatment capacity of LA procedures independent of calculated PV or BV the capacity threshold was determined in addition. During LA procedures every 20 min cholesterol, triglycerides, LDL-C, HDL-C and Lp(a) concentrations were determined and related to the hematocrit to exclude dilution effects.
Results:
In patients undergoing regular LA treated volumes vs. calculated volumes were different: for PV 28 ± 18% (n = 7); for BV 28 ± 20% (n = 6). The mean treated volumes were 1.3 fold larger than the calculated volumes to achieve cholesterol target levels in most LA treatments. With respect to the capacity threshold we observed in only 1 of 13 patients an ineffective long treatment time. No LA procedure failed due to exhausted capacity.
Conclusions:
Lipoprotein apheresis treatment is a very effective treatment procedure in lowering LDL-C and Lp(a). However, not in all procedures the optimal treatment volume for LA patients may be calculated. However calculations of PV and BV are more or less error-prone. An increase of 1.3 fold in the calculated volumes may be the first step in optimizing individual LA treatment options. In addition, to exclude an exhaustion of LA procedures the determination of the individual capacity threshold in every LA patient may be further helpful to adjust treatment volumes. To substantiate our demand on changed treatment volumes further data are necessary.
