The Effect of Low-Density-Lipoprotein (LDL) Apheresis on Patients Treated with Hemodialysis : The Influence in Diabetic Nephropathy with Arteriosclerosis Obliterans

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  • 維持血液透析患者に対するLDLアフェレシスの効果 : 閉塞性動脈硬化症を合併した糖尿病性腎症に対して

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Abstract

Recently, low-density-lipoprotein (LDL) apheresis has been applied to patients with arteriosclerosis obliterans (ASO). Using this method, we treated 57 diabetic patients with ASO who has been treated using hemodialysis and evaluated the effects of LDL apheresis. At 3 months after 10 cycles of LDL apheresis, many symptoms for such as intermittent claudication and walking distance improved for 32 diabetic patients. The level of serum cholesterol, LDL cholesterol, triglycerides and/or lipoproteins (a) (Lp (a)) was significantly reduced in all patients. On the other hand, the values of plasma bradykinin, serum nitric oxide (NO) and/or hepatocyte growth factor (HGF) increased. LDL cholesterol, Lp (a) and NO levels before treatment with LDL apheresis were significantly lower in patients with positive reactions to LDL apheresis as compared to patients where treatment was ineffective (88.7±7.1 vs. 100.5±6.9 mg/dl, P<0.02; 31.6±4.2 vs. 40.2±2.6mg/dl, p<0.01; 52.3±5.8vs. 113.1±29.1 μmol/L, p<0.01 respectively). Additionally, the increase in NO level after LDL apheresis was significantly larger in the patients with a positive reaction (19.1±2.5 vs. 1.7±0.5%, p<0.01). In patients where treatment was ineffective, the PTH level was higher and duration of hemodialysis was longer. Therefore we assumed that their atherosclerosis and endothelial injuries were more serious. We concluded that LDL apheresis induced the production of bradykinin, NO and HGF, and caused an improvement of microcirculation in peripheral extremities. These changes are more evident in patients with milder vascular endothelial injuries.

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