Case Series: Management of Elevated Lipoprotein(a) by Double-Filtration Plasmapheresis in Hemodialysis Patients With Chronic Kidney Disease.

BACKGROUND: Elevated lipoprotein(a) (Lp(a)) is a recognized independent cardiovascular risk factor, particularly in patients with chronic kidney disease (CKD) undergoing hemodialysis, for whom pharmacological treatment options remain limited. Lipoprotein apheresis with double-filtration plasmapheresis (DFPP) is a semiselective apheresis technique associated with reductions in serum Lp(a) levels. OBJECTIVE: To describe the clinical and biological outcomes of lipoprotein apheresis with DFPP in five hemodialysis patients with markedly elevated Lp(a) levels (> 200 nmol/L) and a history of cardiovascular disease (CVD). METHODS: We report a case series of five CKD patients undergoing hemodialysis who underwent lipoprotein apheresis with DFPP, either concomitantly with hemodialysis or separately depending on hemodynamic tolerance. Biological parameters, including Lp(a), low-density lipoprotein (LDL) cholesterol, triglycerides, fibrinogen, blood pressure, and session characteristics (plasma volume treated and session duration), were assessed before and after lipoprotein apheresis sessions with DFPP. RESULTS: All patients experienced marked reductions in Lp(a), LDL cholesterol, triglycerides, and fibrinogen following lipoprotein apheresis sessions. The procedure was performed concomitantly with hemodialysis in four patients with stable hemodynamic parameters. In one patient, the procedure was carried out separately from hemodialysis because of hemodynamic intolerance. CONCLUSION: Lipoprotein apheresis with DFPP appeared effective in reducing elevated Lp(a) levels and was generally well tolerated in hemodialysis patients.