Biosorption of potassium ion using bean seeds and its energy saving application.

Ca and Mg have been implicated in causing hardness in beans resulting in relatively long cooking time. This study used potassium to replace the cations and determined the adsorption of potassium solution to bean seeds. Then, plantain peel, a natural source of potassium, was used to cook beans and its impact on the cooking time of beans was investigated. The adsorption experiments were performed using batch technique, while metal compositions of the bean seeds and plantain peel were determined by spectroscopy. Optimum removal conditions of potassium ion biosorption using bean seeds were observed at pH 10.2, 2 g bean seed dosage, 180 min agitation time, with 75 ppm as initial metal concentration. The kinetic model correlate with pseudo-second order reaction and the Langmuir adsorption model best fitted the adsorption. After cooking the beans with plantain peel, the concentration of Mg reduced in the bean seeds by about 48%, while the concentration of Ca reduced by about 22%, but the concentration of K increased by over 200% in the cooked bean seeds. Beans treated with plantain peel cooked earlier than the control experiment. This may be affected by pH, adsorbent dosage, metal concentration and contact time.

Precision Medicine Approach for Cardiometabolic Risk Factors in Therapeutic Apheresis.

Lipoprotein apheresis (LA) is currently the most powerful intervention possible to reach a maximal reduction of lipids in patients with familial hypercholesterolemia and lipoprotein(a) hyperlipidemia. Although LA is an invasive method, it has few side effects and the best results in preventing further major cardiovascular events. It has been suggested that the highly significant reduction of cardiovascular complications in patients with severe lipid disorders achieved by LA is mediated not only by the potent reduction of lipid levels but also by the removal of other proinflammatory and proatherogenic factors. Here we performed a comprehensive proteomic analysis of patients on LA treatment using intra-individually a set of differently sized apheresis filters with the INUSpheresis system. This study revealed that proteomic analysis correlates well with routine clinical chemistry in these patients. The method is eminently suited to discover new biomarkers and risk factors for cardiovascular disease in these patients. Different filters achieve reduction and removal of proatherogenic proteins in different quantities. This includes not only apolipoproteins, C-reactive protein, fibrinogen, and plasminogen but also proteins like complement factor B (CFAB), protein AMBP, afamin, and the low affinity immunoglobulin gamma Fc region receptor III-A (FcγRIIIa) among others that have been described as atherosclerosis and metabolic vascular diseases promoting factors. We therefore conclude that future trials should be designed to develop an individualized therapy approach for patients on LA based on their metabolic and vascular risk profile. Furthermore, the power of such cascade filter treatment protocols may improve the prevention of cardiometabolic disease and its complications.

Evaluating the locally sourced materials as fluid loss control additives in water-based drilling fluid.

In the exploration for hydrocarbons, a successful drilling operation to the desired depth hinges on the effective performance of the formulated drilling fluid. Apart from carrying drill cuttings to the surface, another major function of the fluid is to seal off the walls of the wellbore to prevent fluids from coming into and out of the wellbore while drilling a well. Numerous commercial fluid loss additives: carboxymethyl cellulose (CMC), polyanionic cellulose (PAC), among others have been in existence with their drawbacks and effect on the total drilling cost. This study evaluates the use of locally sourced materials: Detarium microcarpum, Brachystegia eurycoma and rice husk, as fluid loss control additive in the water-based drilling fluid. The materials were prepared, ground and sieved to 125 microns. Four sets of water-based drilling muds were formulated using the local materials and CMC as fluid loss control additives. The mud formulation was based on the American Petroleum Institute (API) standard of 25g bentonite to 350mL of water. Also, the filtration test of the formulated muds was performed using API recommended practice for static filtration test at low temperature - low pressure (LTLP) condition. The results obtained showed that Detarium microcarpum and rice husk fluid loss volume and filter cake thickness were comparable with that of CMC from additive content of 10g, while Brachystegia eurycoma was comparable from additive content of 15g. Furthermore, the composite additive results indicated that Detarium microcarpum-rice husk at 95% Detarium microcarpum-5% rice husk performed better than Brachystegia eurycoma-rice husk of the same combination. Additionally, the fluid loss volume and filter cake thickness of Detarium microcarpum-rice husk additive were comparable with CMC from 10g content. Also, the results revealed that the fluid loss volume and filter cake thickness obtained from the locally sourced materials were within API specification for fluid loss control agents. The mud filter cake characteristics exhibited by these materials depicted that they have slippery, smooth and soft mud cakes; thus, the characteristics of a good mud cake that will prevent differential pipe sticking.

Biosorptive interaction of alkaline modified Dialium guineense seed powders with ciprofloxacin in contaminated solution: central composite, kinetics, isotherm, thermodynamics, and desorption.

This work evaluated the use of Dialium guineense seed waste (DGS) and its sodium hydroxide modified form (NH-DGS) as biosorbent for ciprofloxacin (CPF) from synthetic solution as well as the desorption potentials. Central composite design (CCD) was applied for optimization of the alkaline treated biosorbent by response surface methodology using design expert. Both biosorbents were characterized by FTIR, SEM, EDX, and BET analysis. The CCD showed NaOH concentration of 0.46 M and temperature of 96 °C to be effective for optimized modification of NH-DGS. Optimum removal of CPF was obtained at pH 6.0, contact time 120 min, temperature 300 K, and dosage of 0.1 g. The Freundlich model gave the best fit compared to the other isotherms tested with R2 values >0.97951. NH-DGS exhibited a maximum uptake capacity of 120.34 mg/g higher than some reported adsorbents for CPF. The pseudo-second-order model was suitable in the fitting of the kinetic data. A non-spontaneous process was obtained for CPF biosorption on DGS which became spontaneous after alkaline treatment. Over 84% desorption of CPF was achieved on both biosorbents using 0.3 M HCl which envisaged the use of NH-DGS as an efficient material for treatment of waters contaminated with CPF.

Rice husk and saw dust as filter loss control agents for water-based muds.

When drilling with water based muds (WBM), significant fluid loss volumes from the mud into the formation can have adverse effects not just on the mud and its properties but also on the stability of the wellbore. Prevention of mud filter loss is one way of assessing the performance of a drilling mud. However, evaluation of the effectiveness or otherwise of a fluid loss control additive can be made by characterizing the mud cake formed. Interestingly, the mud cake characterization is one area that has been somewhat neglected in drilling fluid formulation with agro waste materials. Two cellulosic materials - rice husk and saw dust were chosen for the experimental study. The specie of the rice husk used was the African rice (Oryza glaberrima) while the dust from the saw milling of Oxystigma manni was utilized for this study. To ensure result acceptability, the rice husk and saw dust were ground and the resulting products were sieved to 1.25 × 10-4 m. The filtration characteristics of the formulated mud samples were tested using the American Petroleum Institute (API) filter press and in accordance to the API recommended practice for field testing WBMs. From the filter loss tests, it was observed that the ground rice husk prevented filter loss by an average of 77% compared to ground saw dust filtration control of 63%. In addition, it was observed that at higher concentrations, ground saw dust and rice husk prevented fluid loss to the minimum acceptable API standard. For the filter cake thickness measured in millimetres, ground rice husk exhibited thicker mud cakes when compared with the saw dust by an average amount of 14%. For the mud cake characteristics, the rice husk mud exhibited smooth and slippery cakes while the saw dust mud exhibited rough texture, sticky and firm cakes.

Lipoprotein apheresis is an optimal therapeutic option to reduce increased Lp(a) levels.

BACKGROUND: Lipoprotein(a) (Lp(a)) is a genetic risk factor for cardiovascular disease (CVD) and is associated with the induction and sustaining of atherosclerotic cardiovascular diseases (ASCVD). Since 2008 Lp(a) along with progressive CVD has been approved as an indication for regular lipoprotein apheresis (LA) in Germany. The German Lipoprotein Apheresis Registry (GLAR) has been initiated to provide statistical evidence for the assessment of extracorporeal procedures to treat dyslipidemia for both LDL-cholesterol (LDL-C) and Lp(a). The GLAR now allows prospective investigations over a 5-year period about annual incidence rates of cardiovascular events. Here Lp(a) patients (LDL-C < 100 mg/dl; Lp(a) > 60 mg/dl or >120 nmol/l) showed the same reduction of major coronary (83%) and non-coronary events (63%) as had been formerly shown in the Pro(a)LiFe study. However, Lp(a) is not only an apolipoprotein(a) (apo(a)) and LDL-C containing particle, which is covalently bound to a LDL-C core by a disulphide bridge. The composition of this particle, inter alia containing oxidized phospholipids, gives pro-atherosclerotic, pro-inflammatory, and pro-thrombotic properties, inducing atherosclerotic processes mainly in the arterial wall. However, recent investigations have shown that a reduction of inflammatory settings without LDL-C or Lp(a) reduction may reduce ASCVD events. Lipoprotein apheresis (LA) could not only reduce LDL-C and Lp(a) in parallel, but also different inflammatory and coagulation parameters. In summary lipoprotein apheresis is not only anti-atherosclerotic, but also anti-inflammatory and anti-thrombotic and therefore an ideal treatment option with respect to the shown reduction of major adverse coronary events (MACE) and major adverse non-coronary events (MANCE) by reducing Lp(a) levels.

Lipoprotein(a) and proprotein convertase subtilisin/kexin type 9 inhibitors.

Lipoprotein(a) (Lp(a)) is an internationally accepted independent atherogenic risk factor. Details about its synthesis, many aspects of composition and clearance from the bloodstream are still unknown. LDL receptor (LDLR) (and probably other receptors) play a role in the elimination of Lp(a) particles. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors increase the number of available LDLRs and in this way very effectively reduce the LDL cholesterol (LDL-C) concentrations. As shown in controlled studies using PCSK9 inhibitors, Lp(a) levels are decreased by 20 to 30%, though in some patients no effect was observed. So far, it has not been clarified whether this decrease is associated with an effect on the incidence of cardiovascular events (CVEs). In two recently published well-performed secondary prevention studies (FOURIER with evolocumab, ODYSSEY OUTCOMES with alirocumab) baseline Lp(a) levels were shown to have an impact on CVEs independently of baseline LDL-C concentrations. The rather modest PCSK9 inhibitor-induced decrease of Lp(a) was associated with a reduction of CVEs in both studies, even after adjusting (ODYSSEY OUTCOMES) for demographic variables (age, sex, race, region), baseline Lp(a), baseline LDL-C, change in LDL-C, and clinical variables (time from acute coronary syndrome, body mass index, diabetes, smoking history). The largest decrease of CVEs was seen in patients with relatively low concentrations of both LDL-C and Lp(a) (FOURIER). These findings will probably have an influence on the use of PCSK9 inhibitors in patients with high Lp(a) concentrations.

Lipoprotein(a)-an interdisciplinary challenge.

Lipoprotein(a) (Lp(a)) is an internationally recognized atherogenic risk factor which is inherited and not changed by nutrition or physical activity. At present, only proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors may modestly decrease its concentration (but not in all patients)-leading to a certain decrease in cardiovascular events (CVE) in controlled studies. However, at present an elevation of Lp(a) is not a generally accepted indication for their use. More effective is lipoprotein apheresis (LA) therapy with respect to both lowering Lp(a) levels and reduction of CVE. In the future, an antisense oligonucleotide against apolipoprotein(a) will probably be available. Atherosclerosis in patients with an elevation of Lp(a) may affect several vessel regions (carotids, aorta, coronaries, leg arteries). Thus, Lp(a) should be measured in high-risk patients. These patients are usually cared for by their family doctors and by other specialists who should closely cooperate. Lipidologists should decide whether costly therapies like PCSK9 inhibitors or LA should be started. The main aim of current therapy is to optimize all other risk factors (LDL cholesterol, hypertension, diabetes mellitus, body weight, renal insufficiency). Patients should be regularly monitored (lab data, heart, arteries). This paper describes the duties of physicians of different specialties when caring for patients with high Lp(a) concentrations.

Treatment-related and health-related quality of life in lipoprotein apheresis patients.

BACKGROUND: There is evidence for beneficial effects of lipoprotein apheresis (LA) in terms of reduction of cardiovascular events and interventions, but quality of life (QOL) in LA patients has only been explored in small samples. OBJECTIVE: In this study, both LA- or treatment-related and health-related QOL (HRQOL) were assessed in 206 LA patients. METHODS: Mental and physical HRQOL of the LA patients was assessed by means of the SF-12 as well as the EQ-5D. Physical complaints were assessed by the Patient Health Questionnaire-15 and LA- or treatment-related QOL by the Apheresis Quality of Life Form, developed for this study. RESULTS: Comparison with general population norms showed that LA patients scored significantly lower on HRQOL and significantly higher on physical complaints. A higher perceived impact of the treatment proved to have a significant negative association with HRQOL and a positive one with physical complaints. CONCLUSION: Previous studies reported higher levels of QOL in LA patients. This study showed that treatment-related QOL contributes to HRQOL and physical complaints in LA patients. While many patients do not experience LA as a real burden and report positive effects of the treatment, there is also an important group of patients for whom this is not the case. Although the impact on QOL of LA patients does most probably not outweigh the cardiovascular benefits of the treatment, it is important to screen treatment-related QOL in LA patients to optimize care in a personalized way. Future research is needed to compare QOL in LA with non-LA patients with similar medical conditions.

Lipoprotein apheresis influences monocyte subpopulations.

BACKGROUND: Monocytes can be differentiated into subpopulations depending on their expression profile of CD14 and CD16. CD16-positive monocytes are associated with coronary artery disease. Up to now, no data exist about the effect of lipoprotein apheresis (LA) on the distribution of monocyte subpopulations. METHODS: 80 patients who underwent LA at the University Hospital Dresden were included in the study. 8 out of the 80 LA patients received LA for the first time at the time point of blood analysis. Six different methods of LA were used (H.E.L.P. n = 8; Liposorber D n = 10; LF n = 14; DALI n = 17; MONET n = 11; Therasorb® LDL n = 12). Blood samples were taken immediately before and after LA and analyzed for CD14 and CD16 expression on monocytes. A total of 42 patients with cardiovascular risk factors but no indication for LA served as control group. RESULTS: The composition of monocyte-population was analyzed in regard to the 3 subpopulations. After LA, an increase in classical monocytes (CD14++CD16-) (93.3% vs. 93.9%, p < 0.01) and a decrease in non-classical monocytes (CD14+CD16+) (1.5% vs 1.0%; p < 0.001) were observed. LA did not change the amount of intermediate monocytes (CD14++CD16+) (5.3% vs. 5.1%). Two methods (MONET and Therasorb® LDL) did not influence the distribution of monocyte subpopulations. Interestingly, patients with LDL-C above 2.5 mmol/l prior LA showed increased amounts of intermediate monocytes. CONCLUSION: The distribution of monocyte populations is influenced by LA but depends on the distinct method of LA. Influences of LA were mainly observed in the content of classical and non-classical monocytes, whereas the intermediate monocyte population remained unaltered by LA.

Kinetics of Lipoprotein(a) in patients undergoing weekly lipoprotein apheresis for Lp(a) hyperlipoproteinemia.

INTRODUCTION: Lipoprotein apheresis (LA) represents the only effective therapeutic option for patients with elevated Lipoprotein(a) (Lp(a)) levels. We aimed at analyzing the Lp(a) reduction, rebound rates as well as mean interval values between two weekly apheresis sessions, since this might be important for the prediction of the residual cardiovascular risk and development of individualized approaches for this special therapeutic strategy. MATERIALS AND METHODS: 20 patients under weekly and 2 patients under twice weekly apheresis were included. We measured serum concentrations of Lp(a), total, LDL-, HDL - cholesterol and triglycerides daily over 7 days after single LA sessions. RESULTS: Mean Lp(a) levels was 158.1 ± 69.82 nmol/l before the LA session, decreased acutely by 76 ± 7% and increased to 97 ± 13% of the baseline value within 7 days in patients under weekly treatment. By mathematical modeling, the acute Lp(a) reduction can be calculated from the function: y (nmol/l) = 3.415 + 0.738 * x (R2 = 0.970), where x is the baseline Lp(a) value. The recovery rate can be predicted from the equation: y (%) = 22.49 + 18.64 * x - 1.14 * x2 (R2 = 0.874), where x is the day after apheresis. The empirical formula for the mean interval value is: y (nmol/l) = x - 12, where x is the absolute reduction in nmol/l. CONCLUSION: We modeled - for the first time - equations to predict the course of Lp(a) serum levels under weekly LA which are simple, reliable and enable the development of optimal individualized protocols of this costly lipid lowering therapy.

Most significant reduction of cardiovascular events in patients undergoing lipoproteinapheresis due to raised Lp(a) levels - A multicenter observational study.

OBJECTIVES: Lipoprotein(a) (Lp(a)) is an independent cardiovascular (CV) risk factor, predisposing to premature and progressive CV events. Lipoproteinapheresis (LA) is the only efficacious therapy for reducing Lp(a). Data comparing the clinical efficacy of LA with respect to reduction of CV events in subjects with elevated Lp(a) versus LDL-C versus both disorders is scarce. We aimed to perform this comparison in a multicenter observational study. METHODS: 113 LA patients from 8 apheresis centers were included (mean age 56.3 years). They were divided into 3 groups: Group I: Lp(a) < 600 mg/l, LDL-C > 2.6 mmol/l, Group II: Lp(a) > 600 mg/l, LDL-C < 2.6 mmol/l, and Group III: Lp(a) > 600 mg/l, LDL-C > 2.6 mmol/l. CV events were documented 2 years before versus 2 years after LA start. RESULTS: Before start of LA Group II showed the highest CV event rate (p 0.001). Group III had a higher CV event rate than Group I (p 0.03). During LA there was a significant reduction of CV events/patient in all vessel beds (1.22 ± 1.16 versus 0.33 ± 0.75, p < 0.001). The highest CV event rate during LA was seen in coronaries followed by peripheral arteries, cerebrovascular events were least common. Greater CV event reduction rates were achieved in patients with isolated Lp(a) elevation (-77%, p < 0.001) and in patients with Lp(a) and LDL-C elevation (-74%, p < 0.001) than in subjects with isolated hypercholesterolemia (-53%, p 0.06). CONCLUSION: This study demonstrates that patients with Lp(a) elevation benefit most from LA treatment. Prospective trials to confirm these data are warranted.

Current insights into the German lipoprotein apheresis standard: PCSK9-inhibitors, lipoprotein apheresis or both?

According to current European guidelines, lipid lowering therapy for progressive cardiovascular disease including cardiovascular events has to be focused on a target level for LDL-C. In contrast for Lp(a) a threshold has to be defined with respect to the method of measurement. However, due to new lipid lowering drug developments like PCSK9-inhibitors (PCSK-9-I) a therapeutic algorithm for patients with severe hypercholesterolemia or isolated Lipoprotein(a)-hyperlipoproteinemia with progressive cardiovascular disease may be necessary to manage the use of PCSK9-I, lipoprotein apheresis (LA) or both. The therapeutic approach for patients with homozygous familial hypercholesterolemia is unambiguous: In addition to LA, in order to improve LDL-C reduction, PCSK9-I could be applied. In patients with heterozygous familial hypercholesterolemia, PCSK9-I is to be applied first. If in addition to a pronounced LDL-C elevation, cardiovascular complications exist or if imaging techniques documented atherosclerotic changes pre-disposing for a cardiovascular event while LDL-C reduction is insufficiently reduced (LDL-C > 100 mg/dl (2.6 mmol/l)), LA treatment should then be applied as last resort. In patients with elevated Lp(a) concentrations (Lp(a) > 60 mg/dl (>120 nmol/l)) and established cardiovascular disease, therapy should rely primarily on LA methods. If in addition to high Lp(a) levels insufficiently treated LDL-C concentrations (LDL-C > 100 mg/dl (2.6 mmol/l)) exist, in rare cases PCSK9-I can supplement the lipid lowering concept.

Current insights into the German Lipoprotein Apheresis Registry (GLAR) - Almost 5 years on.

BACKGROUND: In recent years the Federal Joint Committee (G-BA), a paramount decision-making body of the German health care system required a reassessment of the approval of chronic lipoprotein apheresis therapy for regular reimbursement. Since 2005 an interdisciplinary German apheresis working group has been established by members of both German Societies of Nephrology. In 2009 the working group completed the indication for lipoprotein apheresis with respect to current cardiovascular guidelines and current scientific knowledge for the registry. In 2011 the German Lipoprotein Apheresis Registry (GLAR) was launched and data acquired over nearly 5 years can now be reported. METHODS AND RESULTS: All data were collected and analyzed during the time period 2012-2015. Over this time interval, 68 German apheresis centers collected retrospective and prospective observational data of 1.283 patients undergoing lipoprotein apheresis (LA) treatment of high LDL-cholesterol (LDL-C) levels and/or high lipoprotein(a) (Lp(a)) levels suffering from progressive cardiovascular disease (CVD). A total of 15,167 documented LA treatments were investigated. All patients treated by LA exhibited a median LDL-C reduction rate of 68.6%, and a median Lp(a) reduction rate of 70.4%. Analogue to the Pro(a)LiFe pattern, patient data were analyzed and compared with respect to the incidence rate of coronary events (MACE) 1 and 2 years before the start of LA treatment (y-2 and y-1) and prospectively one year on LA treatment (y+1). During the first year of LA treatment a MACE reduction of 97% was be observed. In the years considered, LA treatment side effects occurred at a low rate (ca. 5%) and mainly comprised puncture problems. CONCLUSIONS: For the first time data generated by the GLAR shows that LA lowers the incidence rate of cardiovascular events in patients with high LDL-C and/or high Lp(a) levels, progressive CVD and maximally tolerated lipid lowering medication. In addition LA treatments were found to be safe, exhibiting a low rate of side effects.

The German Lipoprotein Apheresis Registry (GLAR) - almost 5 years on.

BACKGROUND: Since 2005 an interdisciplinary German apheresis working group has been established by members of both German Societies of Nephrology and of Lipidologists and completed the data set for the registry according to the current guidelines and the German indication guideline for apheresis in 2009. In 2011 the German Lipoprotein Apheresis Registry (GLAR) was launched and data are available over nearly 5 years now. METHODS AND RESULTS: During the time period 2012-2016, 71 German apheresis centers collected retrospective and prospective observational data of 1435 patients undergoing lipoprotein apheresis (LA) treatment of high LDL-C levels and/or high Lp (a) levels suffering from cardiovascular disease (CVD) or progressive CVD. A total of 15,527 completely documented LA treatments were entered into the database. All patients treated by LA showed a median LDL-C reduction rate of 67.5%, and a median Lp (a) reduction rate of 71.1%. Analog to the Pro(a)LiFe pattern, patient data were analyzed to the incidence rate of coronary events (MACE) 1 and 2 years before the beginning of LA treatment (y-2 and y­1) and prospectively two years on LA treatment (y + 1 and y + 2). During two years of LA treatment a MACE reduction of 78% was observed. In the years considered, side effects of LA treatment were low (5.9%) and mainly comprised puncture problems. CONCLUSIONS: The data generated by the GLAR shows that LA lowers the incidence rate of cardiovascular events in patients with high LDL-C and/or high Lp (a) levels, progressive CVD, and maximally tolerated lipid lowering medication. In addition, LA treatments were found to be safe with a low rate of side effects.

Preparation and Evaluation of Adsorbents from Coal and Irvingia gabonensis Seed Shell for the Removal of Cd(II) and Pb(II) Ions from Aqueous Solutions.

Cd(II) and Pb(II) ions removal using adsorbents prepared from sub-bituminous coal, lignite, and a blend of coal and Irvingia gabonensis seed shells was investigated. Fourier transform infrared, scanning electron microscope and X-ray fluorescence analyses implicated hydroxyl, carbonyl, Al2O3, and SiO2 as being responsible for attaching the metal ions on the porous adsorbents. The optimum adsorption of carbonized lignite for the uptake of Cd(II) and Pb(II) ions from aqueous media were 80.93 and 87.85%, respectively. Batch adsorption was done by effect of adsorbent dosage, pH, contact time, temperature, particle size, and initial concentration. Equilibrium for the removal of Pb(II) and Cd(II) was established within 100 and 120 min respectively. Blending the lignite-derived adsorbent with I. gabonensis seed shell improved the performance significantly. More improvement was observed on modification of the blend using NaOH and H3PO4. Pb(II) was preferentially adsorbed than Cd(II) in all cases. Adsorption of Cd(II) and Pb(II) ions followed Langmuir isotherm. The adsorption kinetics was best described by pseudo-second order model. The potential for using a blend of coal and agricultural byproduct (I. gabonensis seed shell) was found a viable alternative for removal of toxic heavy metals from aqueous solutions.

Adverse events of lipoprotein apheresis and immunoadsorption at the Apheresis Center at the University Hospital Dresden.

BACKGROUND: Lipoprotein apheresis and immunoadsorption methods have a firm place among therapeutic approaches in order to treat disorders of lipoprotein metabolism or anti-body induced diseases. The extracorporeal treatment is associated with adverse effects, we wanted to report the Dresden experience. METHODS: In this study we retrospectively analyzed the adverse events of several lipoprotein apheresis and immunoadsorption methods at the Apheresis Center in Dresden (Germany). We carefully looked into all available documents. The first extracorporeal lipoprotein apheresis was performed in 1990 and the first extracorporeal immunoadsorption was executed in 1995. Throughout the 23 years study period, 10 different methods were employed in treating 268 patients for a total of 25,293 treatments. RESULTS: Adverse events of varying severity occurred in 1948 of the treatments (7.7%). We subdivided them into mild (61.3% no treatment was necessary), moderate (37.0% oral medication or infusion was given) and severe (1.7% emergency hospitalization was necessary). Therapy had to be stopped prematurely in 1.5% of the treatments. We compared adverse events profiles among the different methods and evaluated for differences by gender. Females were found to have a significantly higher risk of adverse events than male patients. In males, the rate of adverse events ranged from 3.3% (Liposorber(®) D) to 11% (Therasorb™ Ig); in females the minimum rate was 7.8% (DALI) and the maximum 30% (rheopheresis). Adverse events were evenly distributed between the ages of 30-69, the age range at which most of the therapies were performed. We also found that all methods had a higher rate of adverse events during the first year of treatment. Puncture problems and hypotension were the most common adverse events. CONCLUSION: It can be stressed that in general the extracorporeal methods used can be regarded as safe.