Frequent hemodialysis graft thrombosis: association with antiphospholipid antibodies

We present two cases of patients with systemic lupus erythematosus and end-stage renal disease. Both were on hemodialysis and had multiple arteriovenous graft thromboses associated with the presence of antiphospholipid antibodies. A review of patients with end-stage renal disease secondary to systemic lupus erythematosus reveals that all had borderline or frankly elevated antiphospholipid antibody titers, and four of the seven patients had multiple graft thromboses. Possible etiologic and pathophysiologic mechanisms are discussed.