Rheopheresis for severe peripheral arterial disease in hemodialysis patients: A clinical series

Abstract

Background Rheopheresis is a double‐filtration plasmapheresis that removes high‐molecular‐weight molecules from the plasma and thereby lowers blood viscosity. This treatment has been proposed in hemodialysis (HD) patients for chronic limb‐threatening ischemia (CLTI), but very few studies have evaluated the usefulness of this technique. Principal Objective To assess 1‐year amputation‐free survival (AFS) of HD patients suffering from CLTI treated by rheopheresis. Material and Method We conducted a retrospective study of 28 consecutive HD patients treated by rheopheresis in three French dialysis centers between 1 February 2017 and 30 April 2019 in two indications resulting from CLTI, namely chronic ulceration or recent minor amputation with delayed healing. Results One‐year AFS rate reached 53.6 (−19.8; +16.3)%. One‐year overall survival rate reached 67.9 (−20.5; +13.1)%. Main causes of death were infections and related to palliative care implying reduction or withdrawal of regular dialysis treatment. Hypotension episodes were the main rheopheresis adverse events with a prevalence rate of 13.5%. Rheopheresis sessions significantly reduced fibrinogen, C‐reactive protein, α2‐macroglobulin, total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, triglycerides, IgM, and estimated plasma viscosity (P < .0001). Conclusion Rheopheresis may improve clinical outcomes of CLTI in HD patients. The assessment of rheopheresis effectiveness needs to be confirmed by a multicenter randomized controlled trial, such as the ongoing project in France (RHEO‐PAD, NCT: 03975946).

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

“…In the patients who responded, LA resulted in a short-term decrease in total cholesterol and LDL cholesterol and a long-term reduction of the circulating levels of oxidized LDL, CRP, and fibrinogen. A series of 28 patient treated with a median of 15 procedures (range 6-86) observed a 53.6% 1 year amputation free survival rate and 71.4% complete wound healing within 1 month, however 30.4% had relapse with a new lesion after treatment was stopped (Solignac, 2022).…”

Clinical impact of a novel lipoprotein apheresis treatment on no‐option chronic limb‐threatening ischemia: Result from the REDUCTION VISCOSITY study

“…These LA include double filtration plasmapheresis (DFPP), heparin-induced extracorporeal lipoprotein precipitation (HELP) and direct adsorption of lipoproteins (DALI), etc. [16] One type of DFPP showed that it might improve 1-year amputation free survival in HD patients with CLTI by effectively decreasing the viscosity-related parameters, including fibrinogen, CRP, and LDL-C [17]. Another study with the use of DALI demonstrated significant change in CRP, implying the contribution to the stabilization of atherosclerosis [18].…”