Lipidfiltration: well-established across Germany

Physicians from over 150 centers in Germany are regularly using lipid apheresis as part of treatment. Over the past 30 years, more than 1 million Lipidfiltration treatments have been carried out across the country. Nephrologists – often with further training as lipidologists (DGFF - “German Lipid Association”) – are offering this specialist, selective treatment in their dialysis centers. As specialists in the field of extracorporeal approaches to cleaning the blood, these physicians have a wealth of experience and specialist expertise. When used as part of outpatient care in Germany, lipid apheresis can be reimbursed by statutory health insurance bodies on submission of a special application.
When can lipid apheresis be of benefit?

When can lipid apheresis be of benefit?

LDL cholesterol and lipoprotein(a) can be highly elevated for genetic reasons. This may lead to formation of atherosclerotic plaques and, subsequently plaque ruptures. The risk of preliminary heart attack or stroke occurring is highly increased.

In severe heterozygous familial hypercholesterolemia (FH), a strict diet combined with medications will often lead to a significant reduction of LDL cholesterol. Depending on the patient’s risk profile, this may not be sufficient. Cardiovascular diseases can still develop over time.

In patients with homozygous FH, medications alone frequently do not have the desired effect, or the effect is inadequate. As a consequence, LDL cholesterol values remain highly elevated.

Although there are a range of different medications that are effective and have been approved for reducing LDL cholesterol, there is currently no approved medication available for effectively reducing lipoprotein(a). Diet and lifestyle modification measures have no impact on blood concentrations.

Lipid apheresis may be indicated, if cardiovascular diseases continue to proceed and the lipid values remain high despite maximal therapy. Regular lipid filtration treatments can be used to significantly reduce lipid levels in the blood.

What are LDL cholesterol and lipoprotein(a)?

LDL cholesterol functions to transport cholesterol that is synthesized in the liver via the blood to reach the different organs of the body. When there is excessive LDL cholesterol, dangerous fatty deposits can form on vessel walls. Lipoprotein(a) can be dangerous in two ways: It has the same deleterious effects as LDL cholesterol, but is also responsible for causing thrombotic events.

The figures below outline the molecular structure of LDL cholesterol and lipoprotein(a). Lipoprotein(a) is characterized by apolipoprotein(a) (Apo-a). A part of Apo(a) is structurally similar to plasminogen, and has proatherogenic, proinflammatory and prothrombotic effects.

How does Lipidfiltration work?

There is over 30 years of documented experience on Lipidfiltration with DIAMED. Physicians and particular specialists in extracorporeal blood treatments make a broad use of this technique in their day-to-day clinical work. Vascular access can be achieved via peripheral punction or a shunt. In the Plasmaflo the blood is separated into a cell-rich fraction and the blood plasma. Subsequently the plasma is filtered using a second filter – the Lipidfilter. LDL-cholesterol and lipoprotein(a), but also fibrinogen and triglycerides, are selectively retained. The purified plasma is then re-combined with the cell-rich component of the blood, and this is returned to the patient. The aim is to achieve a treatment plasma volume of between 2,500 ml and 5,000 ml, depending on the weight of the patient.

How effective is lipid filtration?

The clinical efficacy of Lipidfiltration for removal of lipoprotein(a) has been investigated in one of the world’s largest prospective studies on lipid apheresis (n = 170 patients). The results, published in 2013 in the specialist journal “Circulation”, reported a 77% reduction in cardiovascular events (MACE-rate) and 90% reduction in cerebrovascular events.

Major Adverse Cardiovascular Event Rate (MACE-rate)

The case numbers for Lipidfiltration were sufficient to demonstrate a significant reduction in the number of events, by 77% (n = 101 patients). The mean rate of cardiovascular events, such as heart attack, occurring showed a significant fall due to Lipidfiltration (p < 0.0001).

Cerebrovascular and peripheral vascular events

Cerebrovascular and peripheral vascular events

The number of cerebrovascular events per year fell from ten to one. Peripheral vascular events, particularly bypasses and stenting of the lower extremities, were reduced by 80% (n = 166 patients).

Improved oxygenation

Improved oxygenation

Lipidfiltration leads to a significant improvement in peripheral perfusion. Therefore, Lipidfiltration can be particularly of benefit for diabetic patients and sufferers of peripheral arterial disease receiving an indication for lipid apheresis in parallel.

What are the benefits offered by Lipidfiltration?

  • Smart and quick treatment

  • Reduction of LDL cholesterol and lipoprotein(a) up to 75%

  • Fibrinogen and triglycerides can also be effectively reduced

  • Well tolerated by patients

High rates of lowering

Lipidfiltration removes 60 to 75% of LDL cholesterol and lipoprotein(a), as well as effectively removing fibrinogen and triglycerides.

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