The Impact of Lipid Apheresis on Changes of Plasma Ions: A Systematic Review and Meta-Analysis

Lipoprotein apheresis reduces low-density lipoprotein (LDL) cholesterol in high-risk patients, but its effects on plasma ion levels remain unclear. The objective of this study was to systematically evaluate the impact of apheresis on plasma calcium, sodium, potassium, magnesium, and chloride concentrations.

Following PRISMA guidelines, we searched MEDLINE/PubMed, Scopus, and Web of Science to June 2025. Studies reporting pre- and post-apheresis ion levels with at least two sessions were included. Weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models. Subgroup analyses and meta-regression explored heterogeneity. Publication bias was assessed with Egger's test.

Twelve studies (10 publications, 328 participants) showed a significant reduction in total calcium after apheresis (WMD = -0.10 mmol/L; 95% CI = -0.15 to -0.05; p < 0.001). Effects were stronger with ≥ 12 months of treatment and in patients with heart disease. No significant changes were found for sodium, potassium, magnesium, or chloride. Meta-regression identified treatment duration and publication year as sources of heterogeneity for calcium outcomes. No publication bias was detected except potentially for magnesium.

Lipoprotein apheresis is associated with modest but significant reductions in plasma calcium, especially in patients with heart disease or prolonged treatment, highlighting the need for electrolyte monitoring. No consistent effects were observed for other plasma ions.