ANTIPHOSPHOLIPIDS IN HEMODIALYSIS-PATIENTS - RELATIONSHIP BETWEEN LUPUS ANTICOAGULANT AND THROMBOSIS

Vascular access thrombosis (VAT) is frequent in some hemodialysis pati ents. Antiphospholipid antibodies (APL) have been involved in thrombos is, and have been reported to be present in a high proportion of patie nts with chronic renal failure. We studied the relationship between AP L and thrombosis in 97 hemodialysis patients (HD). Lupus anticoagulant (LA) was assessed by activated partial thromboplastin time (APTT) and by tissue thromboplastin inhibition assay (TTl). IgG-anticardiolipin (ACA) was measured by a solid phase ELISA. The prevalence of APL was 3 1%; LA was found in 16.5% and was detected in all cases by TTI. Only o ne patient was positive for APTT. ACA was found in 15.5%. Only one pat ient was positive for LA and ACA. We found no relation between APL and age, length of time on dialysis, sex, type of dialysis membrane, drug s, and chronic B and C hepatitis. A high prevalence of APL was found i n patients with undetermined nephropathy. When histories of thrombosis were examined, VAT was found to be significantly more frequent in pat ients with LA than in patients without LA (62% vs. 26%; P = 0.01). Thi s relation was not present with ACA. Since VAT is one of the most freq uent causes of morbidity for HD, diagnostic evaluation of VAT in HD sh ould now include assay for LA.