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Statement by the Society for Nephrology (DGfN)
by Prof. Julia Weinmann-Menke
(05.01.2022) In a statement by the German Society for Nephrology eV (DGfN) eV on lipid apheresis in long- or post-COVID, it states that there is neither a plausible rationale for a possible effectiveness of lipid apheresis in post- / long-COVID nor any evidence. Although there is a rationale for a possible effectiveness of immune adsorption in post / long COVID, there is also no evidence yet.
Many people who were sick with COVID-19 complain of massive long-term consequences. From impaired lung function to headaches, including cognitive limitations and neurological failures, to exhaustion, listlessness and permanent exhaustion (so-called fatigue syndrome). Some of those affected are even no longer able to work.
There are various theories about the pathogenesis of long and post COVID, but the cause has not yet been clarified. Explanatory attempts include endothelial microcirculatory dysfunction, persistent inflammation or autoantibody-mediated autoimmune reactions.
If the latter is confirmed, immune adsorption could be an effective therapeutic method, as it can remove pathogenic components of the immune system (so-called autoantibodies) from the blood. Immune adsorption is used in autoimmune-mediated diseases and is used by nephrologists as a blood purification process. A pilot study on three patients published in June 2021 in a specialist journal of the renowned “Nature Group” showed that the procedure reduced the number of autoantibodies and improved symptoms. There are also other, isolated case reports.
Overall, however, there are no randomized prospective data or large-scale observational studies that would justify the widespread use of this – relatively expensive – method. Due to the increasing evidence of the occurrence of autoimmune phenomena after a COVID-19 infection, studies on the use of immune adsorption are planned here. At this point in time, one has to state that although there is a rationale for a possible effectiveness of immune adsorption in post / long COVID, there is no evidence.
Lipid apheresis is different: it is a group of extracorporeal blood purification processes that can eliminate lipoproteins, in particular LDL cholesterol or Lp (a). It is used to treat complex disorders of lipid metabolism that are resistant to drug therapy. In lipid apheresis, no components of the immune system, e.g. autoantibodies, are removed from the blood, but rather blood lipids. According to the current state of research, these are not suspected to be a possible cause of post / long COVID symptoms.
Although lipids can influence the life cycle of viruses and lipid-lowering therapies may be beneficial for an acute COVID-19 illness, lipid-lowering measures are unlikely to have any effect after the illness has been overcome and the viral load has fallen. Thus the conclusion of the DGfN is: There is neither a plausible rationale for a possible effectiveness of lipid apheresis in post / long COVID nor any evidence. (idw)
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