The Impact of Lipoprotein apheresis on Plasma Protein Levels: A Meta‐Analysis

ABSTRACT Lipoprotein apheresis (LA) is used for severe dyslipidemia but can remove non‐lipid plasma constituents. In this systematic review and meta‐analysis, we synthesized evidence on LA‐associated changes in albumin, total protein (TP), and α2‐macroglobulin (α2M). PubMed, Scopus, and Web of Science were searched from inception to August 2025 for human observational studies reporting pre‐/post‐apheresis values for albumin, TP, or α2M. Pooled effects were summarized as weighted mean differences (WMD) with 95% CIs. Prespecified subgroup analyses included apheresis duration (≥ 1 year vs. < 1 year), disease background, and apheresis method. Twenty‐eight publications met eligibility (albumin: 22 publications/39 studies; TP : 21 publications/34 studies; α2M : 6 publications/7 studies). LA was associated with lower post‐procedure levels of albumin ( WMD = −3.80 g/L; 95% CI : −4.61 to −2.99; p < 0.001), TP ( WMD = −8.73 g/L; 95% CI : −11.06 to −6.41; p < 0.001), and α2M ( WMD = −65.79 mg/ dL ; 95% CI : −88.98 to −42.60; p < 0.001). Reductions were observed across durations (< 1 year and ≥ 1 year), disease groups, and apheresis methods, with larger albumin decreases in DALI ‐based protocols and smaller in other methods. Between‐study heterogeneity was high but diminished in several subgroups; meta‐regression suggested background disease as a potential contributor. Across observational studies, LA reduced albumin, TP , and α2M immediately post‐procedure. Magnitudes vary by method, clinical context, and treatment duration. These findings support routine monitoring of protein profiles during maintenance LA .