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Anticardiolipin antibodies and lupus anticoagulant in end-stage renal disease
F García-Martín1, G De Arriba, T Carrascosa
1Nephrology Unit, Hospital Virgen de la Luz, Cuenca, Spain.
Insights
Antiphospholipid antibodies like anticardiolipin and lupus anticoagulant are common in end-stage renal disease (ESRD). Their prevalence increases with hemodialysis, potentially linked to membrane bioincompatibility, and is associated with thrombotic events.
Area of Science:
- Nephrology
- Immunology
- Hematology
Background:
- Autoimmune conditions like antiphospholipid syndrome are linked to hypercoagulability.
- End-stage renal disease (ESRD) patients exhibit immune dysregulation and increased thrombosis risk.
- Vascular access thrombosis is a complication for hemodialysis patients.
Purpose of the Study:
- To investigate the incidence of thrombotic episodes.
- To determine the prevalence of anticardiolipin antibodies and lupus anticoagulant in ESRD patients.
- To explore the association between these antibodies, hemodialysis, and thrombosis.
Main Methods:
- Study included 73 ESRD patients: 51 on hemodialysis, 22 on conservative treatment.
- Assessed IgG-anticardiolipin and lupus anticoagulant presence.
- Analyzed correlation with hemodialysis membrane type (cuprophane).
Main Results:
- 18% of conservative patients and 37% of hemodialysis patients had IgG-anticardiolipin and/or lupus anticoagulant.
- Hemodialysis patients showed a higher incidence, associated with cuprophane membrane use (P<0.05).
- Six ESRD patients met criteria for antiphospholipid syndrome, with vascular access thrombosis.
Conclusions:
- IgG-anticardiolipin and lupus anticoagulant are frequent in ESRD, increasing with hemodialysis.
- Membrane bioincompatibility may contribute to antibody prevalence in hemodialysis.
- These antibodies are linked to thrombotic events, forming an ESRD-related antiphospholipid syndrome.
Abstract:
Anticardiolipin antibodies are autoantibodies clinically associated with hypercoagulability. Systemic thrombosis and thrombosis of the vascular access for haemodialysis coexist with immunoregulation abnormalities in end-stage renal disease (ESRD). The aim of the present study was to analyse the incidence of thrombotic episodes and the presence of anticardiolipin antibodies and lupus anticoagulant in 73 patients with ESRD--51 on haemodialysis and 22 on conservative treatment. Four (18%) patients on conservative treatment had IgG-anticardiolipin, three of them also having lupus anticoagulant. Sixteen (31%) patients on haemodialysis showed IgG-anticardiolipin and 11 (22%) lupus anticoagulant; overall, 19 (37%) patients on haemodialysis had IgG-anticardiolipin and/or lupus anticoagulant. This greater incidence in haemodialysis was associated with a more frequent use of cuprophane membranes (68% versus 34%, P less than 0.05). Six patients with ESRD--one on conservative treatment--met criteria for the diagnosis of primary antiphospholipid syndrome, clinically characterised by thrombosis of the vascular access. IgG-anticardiolipin and/or lupus anticoagulant are frequently found in ESRD and their incidence increases with haemodialysis, probably due to some kind of membrane bioincompatibility. IgG-anticardiolipin and lupus anticoagulant can be associated with thrombotic episodes, being constituents of an ESRD-related antiphospholipid syndrome.