Brunet P, Aillaud M-F, San Marco M, Philip-Joet C, Dussol B, Bernard D, Juhan-Vague I, Berland Y
Antiphospholipids in hemodialysis patients: Relationship between lupus anticoagulant and thrombosis

Kidney Int (Sep) 48:794-800 1995

Lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) are acquired antiphospholipid antibodies (APL) which appear to be present in an elevated proportion of HD patients and which may be associated with thrombotic complications. Brunet et al measured APL antibody levels in 97 HD patients, and found an APL prevalence of 31%, split evenly between LA (detected by the TTI method) and ACA. Contrary to reports by others, there was no association between APL positivity and use of Cuprophan membranes. Retrospectively, increased LA, but not ACA, was associated with an increased occurrence of graft thrombosis (+LA, graft thrombosis risk 62%; -LA, risk 37%). Interestingly, presence of either LA or ACA was not associated with increased mortality, although most patients with +LA were receiving coumadin. Two years later, measurements were repeated in 8 patients previously positive for ACA and 8 for LA. All of the ACA patients were now negative, whereas 7/11 LA patients remained positive. Despite their findings, the authors do not recommend screening HD patients for LA, nor do they recommend placing all patients who are LA positive on anticoagulation. (Daugirdas)

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Basic hemodialysis : Vascular Access: graft/fistula
CRF by problem area : Anemia/Erythropoietin/Iron