Cardiovascular disease is the most common cause of mortality in patients with chronic kidney disease on hemodialysis. In addition to a high prevalence of traditional cardiovascular risk factors, other specific factors, including uremia and chronic inflammation, seem to contribute to the excess cardiovascular mortality. The findings of Serrano et al. point to a link between IgA antibodies against β2 glycoprotein I and cardiovascular events in renal dialysis patients.
"Thus, the IgA isotype of anti-β2GPI antibodies may be considered to be a genetic marker and/or to be triggered by HD conditions. Our findings, like previous studies  , suggest that it may be beneficial to extend testing for IgA anti-β2GPI to patients who are negative according to the current APS classification criteria, and particularly in ethnic backgrounds with a high incidence of IgA anti-β2GPI. "
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Arteriovenous fistula (AVF) failure is a major cause of morbidity and mortality in hemodialysis patients. We assessed the role of a large panel of acquired and inherited thrombophilic markers in cases of AVF thrombosis among 101 Tunisians on chronic hemodialysis, all with native AVF.
Materials and methods:
In this case-control study, we considered the levels of fibrinogen, factor II, factor VII, factor VIII, factor IX, factor X, factor XI, factor XII, von Willebrand factor, natural coagulation inhibitors, D-Dimer, homocysteine, IgG, IgM and IgA anticardiolipin and anti-β2glycoprotein I (anti-β2GPI), and anti-H/PF4 antibodies; the presence of Lupus Anticoagulant; and genetic markers (Factor V Leiden, prothrombin 20210G>A, MTHFR 677C>T and 1298A>C).
Multivariate analysis indicated that dialysis for >69 months (OR=10.12; 95% CI, 2.53 to 40.52; p=0.001), HPA-3aa genotype (OR=3.58; 95% CI, 1.36 to 9.4; p=0.01) and anti-β2GPI IgA isotype (OR=3.4; 95% CI, 1.21 to 9.55; p=0.02) were independent risk factors for AVF thrombosis in Tunisian hemodialysis patients. Kaplan-Meier analysis showed that AVF survival was significantly lower for patients with anti-β2GPI IgA than for patients without this isotype (log-rank test, p=0.014).
IgA anti-β2GPI may be of clinical relevance among Tunisians. Further studies on the polymorphism of β2GPI and HPA systems would be helpful for identifying patient groups at high risk of AVF failure.
Thrombosis Research 03/2013; 131(5). DOI:10.1016/j.thromres.2013.03.003 · 2.45 Impact Factor
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