Rheopheresis for severe peripheral arterial disease in hemodialysis patients: A clinical series. Issue 1 (7th December 2021) - Solignac, Justine
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).