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Dialyse aktuell 2013; 17(10): 535-539
DOI: 10.1055/s-0034-1367705
Dialyse
© Georg Thieme Verlag Stuttgart · New York

Lipoproteinapherese – Wie sieht die Praxis aus?

Lipoprotein apheresis – What is the practice?
Josef Leebmann
1   Medizinische Klinik, Klinikum Passau (Chefarzt: Prof. Dr. Matthias Wettstein)
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Publication History

Publication Date:
20 January 2014 (online)

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Zusammenfassung

Die extrakorporalen Verfahren der selektiven Lipoproteinapherese (Synonym Lipidapherese) sind als Fortentwicklung des Plasmaaustauschs in Deutschland im Gegensatz zu vielen anderen Ländern seit Jahrzehnten etabliert und fester Bestandteil der Eskalation lipidsenkender Maßnahmen, wenn Diät und kombinierte medikamentöse Therapie nicht ausreichen. War über lange Zeit hauptsächlich die Absenkung des LDL-Cholesterins im Zentrum des Interesses, hat sich in den letzten Jahren der Blick auf weitere Faktoren der Atherosklerose wie Lipoprotein(a) (Lp(a)) und Triglyzeride erweitert. Für Hochrisikopatienten mit familiärer oder schwerer therapierefraktärer Hypercholesterinämie oder isolierter Lp(a)-Hyperlipoproteinämie (Lp(a)-HLP) mit progredienter kardiovaskulärer Gefäßerkrankung ist die Lipoproteinapherese mangels effizienter medikamentöser Möglichkeiten unverzichtbar. Die Behandlung von schweren Hypertriglyzeridämien mittels Lipoproteinapherese ist Bestandteil der klinischen Praxis, wenn diese in der Schwangerschaft auftreten oder als Komplikation eine akute Pankreatitis eintritt. Darüber hinaus hat die Lipoproteinapherese auch in der Langzeittherapie des seltenen Refsum-Syndroms ihren Stellenwert.

Summary

Selective extracorporeal lipoprotein apheresis has been replacing plasma exchange in particular in Germany within recent decades as highly effective and approved therapy, representing the final step of escalating lipid-lowering treatment for patients not adequately responding to diet and drug therapy. Until recently, mainly reduction of LDL cholesterol has been in the focus of interest, this has been expanded to lipoprotein(a) (Lp(a)) and triglycerides. For high-risk patients suffering from familial or severe hypercholesterolemia refractory to diet and drug therapy or isolated Lp(a) hyperlipoproteinemia and progressive cardiovascular disease lipoprotein apheresis must be considered as the only therapeutic option. Lipoprotein apheresis treatment of severe acute or chronic hypertriglyceridemia associated with pregnancy or pancreatitis has also been established in clinical practice. Extracorporeal elimination of lipoprotein phytanic acid complexes by lipoprotein apheresis represents a pathophysiologically guided therapeutic approach, resulting in significant decrease of hospitalization and long-term improvement or stabilization of overall rehabilitation in patients with severe Refsum's disease.

Key words

apheresis - LDL cholesterol - lipoprotein apheresis - lipoprotein(a) - lipoproteins - hypercholesterolemia - hypertriglyceridemia - phytanic acid - Refsum's disease
 

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