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Direct adsorption of lipids (DALI) is the first LDL‐apheresis method compatible with whole blood. Usually, the blood flow rate is adjusted at 60–80 ml/min, which results in session times of about 2 hr. The present study was performed to test the safety and efficacy of low‐density lipoprotein cholesterol (LDL‐C) and lipoprotein (a) [Lp(a)] removal by DALI at high blood flow rates in order to reduce treatment time. Thirteen chronic DALI patients in seven centers suffering from hypercholesterolemia (LDL‐C 162 ± 42 mg/dl at baseline) and coronary artery disease were treated on a weekly or biweekly basis by DALI apheresis. The blood flow rate QBwas held constant for at least two sessions, respectively, and was increased from 60 to 80, 120, 160, 200, and 240 ml/min. All patients had pre‐existing av‐fistulas. The anticoagulation was performed by a heparin bolus plus ACD‐A at a ratio of citrate: blood ranging from 1:20 to 1:90. Clinically, the sessions were well tolerated and only 26/201 sessions (12%) of the treatments were fraught with minor adverse events. Acute LDL‐C reductions (derived from LDL‐C levels determined by lipoprotein electrophoresis) averaged 72/66/60/53/50/48% for QB= 60/80/120/160/200/240 ml/min. Lp(a) reductions were 68/67/62/60/58/56%, whereas HDL‐C losses were ≤10%. Routine blood chemistries and blood cell counts remained in the normal range. Treatment times averaged 142/83/45 min at Qb= 60/120/240 ml/min. On average, DALI LDL‐apheresis could be performed safely and effectively at high blood flow rates up to at least 120 ml/min in patients with good blood access, which significantly reduced treatment time from 142 to 83 min (−42%). J. Clin. Apheresis 18:157–166, 2003. © 2003 Wiley‐Liss, Inc.

Direct adsorption of lipids (DALI) is the first LDL-apheresis method compatible with whole blood. Usually, the blood flow rate is adjusted at 60–80 ml/min, which results in session times of about 2 hr. The present study was performed to test the safety and efficacy of low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) [Lp(a)] removal by DALI at high blood flow rates in order to reduce treatment time. Thirteen chronic DALI patients in seven centers suffering from hypercholesterolemia (LDL-C 162 ± 42 mg/dl at baseline) and coronary artery disease were treated on a weekly or biweekly basis by DALI apheresis. The blood flow rate QB was held constant for at least two sessions, respectively, and was increased from 60 to 80, 120, 160, 200, and 240 ml/min. All patients had pre-existing av-fistulas. The anticoagulation was performed by a heparin bolus plus ACD-A at a ratio of citrate: blood ranging from 1:20 to 1:90. Clinically, the sessions were well tolerated and only 26/201 sessions (12%) of the treatments were fraught with minor adverse events. Acute LDL-C reductions (derived from LDL-C levels determined by lipoprotein electrophoresis) averaged 72/66/60/53/50/48% for QB = 60/80/120/160/200/240 ml/min. Lp(a) reductions were 68/67/62/60/58/56%, whereas HDL-C losses were ≤10%. Routine blood chemistries and blood cell counts remained in the normal range. Treatment times averaged 142/83/45 min at Qb = 60/120/240 ml/min. On average, DALI LDL-apheresis could be performed safely and effectively at high blood flow rates up to at least 120 ml/min in patients with good blood access, which significantly reduced treatment time from 142 to 83 min (−42%). J. Clin. Apheresis 18:157–166, 2003. © 2003 Wiley-Liss, Inc.

Direct adsorption of lipoproteins (DALI) is the first low‐density lipoprotein (LDL)‐apheresis technique by which atherogenic LDL and lipoprotein(a) (Lp(a)) can be selectively removed from whole blood without plasma separation. The present study was performed to evaluate the efficacy, selectivity and safety of long‐term DALI apheresis. Sixty‐three hypercholesterolemic coronary patients were treated by weekly DALI sessions. Initial LDL‐cholesterol (C) plasma levels averaged 238 ± 87 mg/dl (range 130–681 mg/dl). On average, 34 sessions (1–45) were performed processing 1.5 patient blood volumes. The primary aim was to acutely reduce LDL‐C by ≥60% per session. To this end, three different adsorber sizes could be employed, i.e., DALI 500, 750, and 1,000, which were used in 4, 73, and 23% of the 2,156 sessions, respectively. On average, 7,387 ml of blood were processed in 116 min per session. This resulted in the following mean acute changes: LDL‐C 198 → 63 mg/dl (−69%), Lp(a) 86 → 32 mg/dl (−64%), triglycerides 185 → 136 mg/dl (−27%). HDL‐C (−11%) and fibrinogen (−15%) were not significantly influenced. The mean long‐term reduction of LDL‐C was 42% compared to baseline while HDL‐C slightly increased in the long run (+4%). The selectivity of LDL removal was good as recoveries of albumin, immunoglobulins, and other proteins exceeded 85%. Ninety‐five percent of 2,156 sessions were completely uneventful. The most frequent adverse effects were hypotension (1.2% of sessions) and paresthesia (1.1%), which were probably due to citrate anticoagulation. Access problems had to be overcome in 1.5%, adsorber and hardware problems in 0.5% of the sessions. In this multicenter long‐term study, DALI apheresis proved to be an efficient, safe, and easy procedure for extracorporeal LDL and Lp(a) elimination. J. Clin. Apheresis 17:161–169, 2002. © 2002 Wiley‐Liss, Inc.

Direct adsorption of lipoproteins (DALI) is the first low-density lipoprotein (LDL)-apheresis technique by which atherogenic LDL and lipoprotein(a) (Lp(a)) can be selectively removed from whole blood without plasma separation. The present study was performed to evaluate the efficacy, selectivity and safety of long-term DALI apheresis. Sixty-three hypercholesterolemic coronary patients were treated by weekly DALI sessions. Initial LDL-cholesterol (C) plasma levels averaged 238 ± 87 mg/dl (range 130–681 mg/dl). On average, 34 sessions (1–45) were performed processing 1.5 patient blood volumes. The primary aim was to acutely reduce LDL-C by ≥60% per session. To this end, three different adsorber sizes could be employed, i.e., DALI 500, 750, and 1,000, which were used in 4, 73, and 23% of the 2,156 sessions, respectively. On average, 7,387 ml of blood were processed in 116 min per session. This resulted in the following mean acute changes: LDL-C 198 → 63 mg/dl (−69%), Lp(a) 86 → 32 mg/dl (−64%), triglycerides 185 → 136 mg/dl (−27%). HDL-C (−11%) and fibrinogen (−15%) were not significantly influenced. The mean long-term reduction of LDL-C was 42% compared to baseline while HDL-C slightly increased in the long run (+4%). The selectivity of LDL removal was good as recoveries of albumin, immunoglobulins, and other proteins exceeded 85%. Ninety-five percent of 2,156 sessions were completely uneventful. The most frequent adverse effects were hypotension (1.2% of sessions) and paresthesia (1.1%), which were probably due to citrate anticoagulation. Access problems had to be overcome in 1.5%, adsorber and hardware problems in 0.5% of the sessions. In this multicenter long-term study, DALI apheresis proved to be an efficient, safe, and easy procedure for extracorporeal LDL and Lp(a) elimination. J. Clin. Apheresis 17:161–169, 2002. © 2002 Wiley-Liss, Inc.