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Ames PRJ, Merashli M, Bucci T, Pastori D, Pignatelli P, Violi F, Bellizzi V, Arcaro A, Gentile F. Antiphospholipid antibodies in end-stage renal disease: A systematic review and meta-analysis. Hemodial Int 2020; 24:383-396. [PMID: 32524729 DOI: 10.1111/hdi.12847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The relationship between autoimmune hemolytic anemia and antiphospholipid antibodies (aPL) and/or antiphospholipid syndrome has never been systematically addressed. METHODS Systematic review of EMBASE and PubMed databases performed according to PRISMA guidelines from inception to March 2020; meta-analysis performed by Peto's odds ratio for rare events. FINDINGS Forty-five studies with different outcomes met the inclusion/exclusion criteria. The pooled prevalence (PP) of IgG anticardiolipin antibodies (aCL) positivity was greater in end-stage renal disease (ESRD) than controls (20.2% vs. 2.6%, P = 0.001, I2 >80%; I2 = heterogeneity), particularly in hemodialysis patients (18.3% vs. 8%, I2 = 0%). The PP of lupus anticoagulant was greater in ESRD than controls (8.7% vs. 0.2%, P < 0.0001, I2 = 0%). The standardized mean difference of IgG aCL favored ESRD rather than controls (P < 0.0001, I2 =97%). The PP of fistula occlusion was greater in IgG aCL-positive patients than negative patients (39% vs. 27%, I2 =97%); the PP of IgG aCL positivity was greater in patients with fistula occlusion than without fistula occlusion (26.9% vs. 23.2%, P = 0.01, I2 =72%); the same applied to the PP of lupus anticoagulant positivity (23% vs. 0.3%, P < 0.0001, I2 = 0%). The standardized mean difference of IgG aCL favored fistula occlusion (P = 0.004, I2 = 91%). DISCUSSION Lupus anticoagulant relates to ESRD regardless of management whereas IgG aCL relates specifically to ESRD on hemodialysis, but only lupus anticoagulant associates with fistula occlusion. The expression of aPL as patients positive for aPL rather than as titers precludes further assumptions on the relationship.
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Affiliation(s)
- Paul R J Ames
- Immune Response and Vascular Disease Unit, Nova University, Lisbon, Portugal.,Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Mira Merashli
- Department of Rheumatology, American University of Beirut, Beirut, Lebanon
| | - Tommaso Bucci
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Salerno, Salerno, Italy
| | - Daniele Pastori
- Prima Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- Prima Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Francesco Violi
- Prima Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Bellizzi
- Division of Nephrology, Dialysis and Renal Transplantation, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Alessia Arcaro
- Department of Medicine and Health Sciences, Universita' del Molise, Campobasso, Italy
| | - Fabrizio Gentile
- Department of Medicine and Health Sciences, Universita' del Molise, Campobasso, Italy
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Yan Y, Ye D, Yang L, Ye W, Zhan D, Zhang L, Xiao J, Zeng Y, Chen Q. A meta-analysis of the association between diabetic patients and AVF failure in dialysis. Ren Fail 2018; 40:379-383. [PMID: 29724122 PMCID: PMC6014481 DOI: 10.1080/0886022x.2018.1456464] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/21/2017] [Accepted: 03/15/2018] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The most preferable vascular access for patients with end-stage renal failure needing hemodialysis is native arteriovenous fistula (AVF) on account of its access longevity, patient morbidity, hospitalization costs, lower risks of infection and fewer incidence of thrombotic complications. Meanwhile, according to National Kidney Foundation (NKF)̸Dialysis Out-comes Quality Initiative (DOQI) guidelines, AVF is more used than before. However, a significant percentage of AVF fails to support dialysis therapy due to lack of adequate maturity. Among all factors, the presence of diabetes mellitus was shown to be one of the risk factors for the development of vascular access failure by some authors. Therefore, this review evaluates the current evidence concerning the correlation of diabetes and AVF failure. METHODS A search was conducted using MEDLINE, SCIENCE DIRECT, SPRINGER, WILEY-BLACKWELL, KARGER, EMbase, CNKI and WanFang Data from the establishment time of databases to January 2016. The analysis involved studies that contained subgroups of diabetic patients and compared their outcomes with those of non-diabetic adults. In total, 23 articles were retrieved and included in the review. RESULTS The meta-analysis revealed a statistically significantly higher rate of AVF failure in diabetic patients compared with non-diabetic patients (OR = 1.682; 95% CI, 1.429-1.981, Test of OR = 1: z = 6.25, p <.001). CONCLUSIONS This review found an increased risk of AVF failure in diabetes patients. If confirmed by further prospective studies, preventive measure should be considered when planning AVF in diabetic patients.
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Affiliation(s)
- Yan Yan
- Department of Nephrology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Dan Ye
- Jiangxi Medical College of Nanchang University, Jiangxi, People’s Republic of China
| | - Liu Yang
- Department of Nephrology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Wen Ye
- Jiangxi Medical College of Nanchang University, Jiangxi, People’s Republic of China
| | - Dandan Zhan
- Jiangxi Medical College of Nanchang University, Jiangxi, People’s Republic of China
| | - Li Zhang
- Department of Nephrology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Jun Xiao
- Department of Nephrology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Yan Zeng
- Department of Nephrology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Qinkai Chen
- Department of Nephrology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China
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Elzorkany KMA, Montaser BAM, El-Hefnawy SM. Plasma von Willebrand Factor and a Disintegrin and Metalloproteinase with Eight Thrombospondin-type 1 Motif Levels in Hemodialysis Patients: Relation to Vascular Access Thrombosis. Indian J Nephrol 2018; 28:278-282. [PMID: 30158745 PMCID: PMC6094834 DOI: 10.4103/ijn.ijn_184_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Vascular access complications are major issues in hemodialysis (HD) patients, which increase their morbidity and lessen HD efficiency. The aim of this study was to assess von Willebrand factor (VWF), and a disintegrin and metalloproteinase with eight thrombospondin-type 1 motif (ADAMTS13) levels in HD patients and their association with vascular access thrombosis (VAT). This study included a total of 158 individuals including 128 patients undergoing HD for more than 6 months, subdivided into two groups according to the occurrence of the previous episode of VAT; 60 HD patients with VAT and 68 HD patients without VAT and 30 healthy controls. Plasma ADAMTS13 and VWF levels were assessed by enzyme-linked immunosorbent assay technique. There were higher VWF levels and lower ADAMTS13 in HD patients, compared to healthy controls. Furthermore, VWF levels were significantly higher and ADAMTS13 levels were significantly lower in HD patients with VAT than those without VAT. Further prospective studies with large number of patients are thus needed to show if there is causal relationship between higher VWF levels, lower ADAMTS13, and VAT.
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Affiliation(s)
- Khaled M A Elzorkany
- Department of Internal Medicine, Nephrology Unit, Faculty of Medicine, Menoufia University, Egypt
| | - Belal A M Montaser
- Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia Governorate, Egypt
| | - Sally M El-Hefnawy
- Department of Medical Biochemistry, Faculty of Medicine, Menoufia University, Menoufia Governorate, Egypt
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Fekih-Mrissa N, Sayeh A, Baffoun A, Beji M, Mrad M, Hmida J, Nsiri B. Association Between Thrombophilic Gene Mutations and the Risk of Vascular Access Thrombosis in Hemodialysis Patients. Ther Apher Dial 2016; 20:107-11. [PMID: 27004938 DOI: 10.1111/1744-9987.12379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 11/28/2022]
Abstract
The cause of thrombosis in hemodialysis vascular access is considered to be of a multifactorial nature, including stenosis of the venous or arterial connection. Therefore, identification of relevant thrombotic risk factors could lead to an improved antithrombotic therapy. This case control study was performed to evaluate the relationship between Factor V (G1691A and A4070G) and Factor II polymorphisms and vascular access thrombosis in hemodialysis patients. One hundred and twenty-one patients undergoing dialysis were selected as subjects. This sample was divided into two groups; a case group of 60 patients who had sustained one or more thrombotic events that resulted in vascular access failure and a control group of 61 patients, who never had a thrombotic occlusion of a functioning permanent dialysis access. Our data demonstrated a significantly increased risk of vascular access thrombosis in carriers of the mutant FV (G1691A and A4070G) polymorphisms (P < 0.05).Further studies on a large-scale population and other genetic variants will be needed to find candidate genes for vascular access thrombosis in hemodialysis patients.
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Affiliation(s)
| | - Aycha Sayeh
- Laboratory of Molecular Biology, Department of Hematology
| | - Anis Baffoun
- Department of Hemodialysis, Military Hospital of Tunisia, Tunis, Tunisia
| | - Maher Beji
- Department of Hemodialysis, Military Hospital of Tunisia, Tunis, Tunisia
| | - Meriem Mrad
- Laboratory of Molecular Biology, Department of Hematology
| | - Jalel Hmida
- Department of Hemodialysis, Military Hospital of Tunisia, Tunis, Tunisia
| | - Brahim Nsiri
- Laboratory of Molecular Biology, Department of Hematology
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Bauer A, Limperger V, Nowak-Göttl U. End-stage renal disease and thrombophilia. Hamostaseologie 2015; 36:103-7. [PMID: 25639843 DOI: 10.5482/hamo-14-11-0063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/23/2015] [Indexed: 11/05/2022] Open
Abstract
Chronic kidney disease is an established risk factor for arterial and venous thromboembolism (TE). Whereas the overall risk of TE in moderately decreased kidney function is approximately 2.5-fold higher compared to patients with normal renal function, the risk increase is 5.5-fold in patients with severe renal dysfunction. In patients with renal dysfunction and arterial thrombosis (OR: 4.9), malignancy (OR: 5.8) surgery (OR: 14.0) or thrombophilia (OR: 4.3) the risk to suffer from venous TE is higher compared to the risk associated to the baseline renal dysfunction alone. The treatment options for end-stage renal diseases include hemodialysis, peritoneal dialysis and kidney transplantation. During all treatment modalities thrombotic complications have been described, namely catheter malfunction and shunt thrombosis in patients undergoing hemodialysis in up to 25% of patients, and TE, pulmonary embolism or graft vessel thrombosis in approximately 8% of patients. The reported incidence of reno-vascular thrombosis following renal transplantation leading to hemorrhagic infarction with organ rejection or organ loss varied between 2-12%. Keeping in mind the multifactorial etiology of TE in patients with kidney dysfunction a general screening for thrombophilia in this patient group is not indicated. Selected screening on an individual patient basis should be discussed if the family history for TE is positive or the patient itself had suffered one thrombosis before the onset of the renal disease or multiple TEs during hemodialysis or post kidney transplantation in patients waiting for living donor kidney transplantation.
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Affiliation(s)
| | | | - Ulrike Nowak-Göttl
- Prof. Dr. Ulrike Nowak-Göttl, Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, Univ. Hospital Schleswig Holstein, Campus Kiel & Lübeck, Arnold-Heller-Str. 5, 24105 Kiel, E-mail:
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Hadhri S, Rejeb MB, Belarbia A, Achour A, Skouri H. Hemodialysis duration, Human platelet antigen HPA-3 and IgA Isotype of anti-β2glycoprotein I antibodies are associated with native arteriovenous fistula failure in Tunisian hemodialysis patients. Thromb Res 2013; 131:e202-9. [DOI: 10.1016/j.thromres.2013.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 02/04/2013] [Accepted: 03/01/2013] [Indexed: 01/19/2023]
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Abstract
Hemodialysis (HD) is associated with increasing thrombotic trend. Vascular access thrombosis (VAT) increases morbidity in HD patients. The aim of this study was to evaluate ADAMTS13 and VWF plasma levels from patients undergoing HD as putative biomarkers of the hypercoagulability state, as well the association between these markers and VAT occurrence. This study included 195 patients on HD for more than 6 months. HD patients were allocated into two groups according to the occurrence or not of previous episode of VAT; HD with VAT (N = 46) and HD without VAT (N = 149). ADAMTS13 and VWF were performed by ELISA. There was no significant difference between HD patients with and without VAT for ADAMTS13 and VWF levels. However, VWF levels were higher (P < 0.001) and ADAMTS13 were lower (P < 0.001) in HD patients, comparing to the control group composed by healthy subjects without kidney disease, age and sex-matched (N = 80). Taken together our data suggest a potential role of the kidneys function compromised on ADAMTS13 synthesis or metabolism, regardless other known sources of ADAMTS13. The imbalance between ADAMTS13 and VWF levels does not explain the development of VAT in HD patients by itself, although it should contribute for the hypercoagulability state. Therefore, additional studies to identify other risk factors are warranted and essential for better management of HD patients.
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Polat A, Gumus F. Regarding "ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas". J Vasc Surg 2012; 55:1224; author reply 1224. [PMID: 22464467 DOI: 10.1016/j.jvs.2011.11.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 11/28/2011] [Accepted: 11/28/2011] [Indexed: 11/25/2022]
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Cho EJ, Kim YC, Hwang JH, Lee H, Park SS, Kim SY, Kim S, Chin HJ. Inherited protein S deficiency due to a novel nonsense mutation in the PROS1 gene in the patient with recurrent vascular access thrombosis: A case report. Kidney Res Clin Pract 2012; 31:72-5. [PMID: 26889411 PMCID: PMC4715088 DOI: 10.1016/j.krcp.2011.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 08/16/2011] [Accepted: 09/14/2011] [Indexed: 11/04/2022] Open
Abstract
Vascular access thrombosis is one of the major causes of morbidity in patients maintained on chronic hemodialysis. Thrombophilia has been recognized as a risk factor of vascular access thrombosis. The authors report a case of inherited protein S deficiency associated with vascular access thrombotic events. DNA sequence analysis of the PROS1 gene identified a novel heterozygous nonsense mutation in exon 10 by transition of AAG (lysine) to TAG (stop codon) at codon 473 (c.1417A>T, p.K473X). Results from the study suggest that the inherited protein S deficiency due to a PROS1 gene mutation may cause vascular access thrombosis in hemodialysis patients.
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Affiliation(s)
- Eun Jin Cho
- Department of Internal Medicine, Seoul National University Hospital, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Korea
| | - Jin Ho Hwang
- Department of Internal Medicine, Seoul National University Hospital, Korea
| | - Hajung Lee
- Department of Internal Medicine, Seoul National University Hospital, Korea
| | - Sung Sup Park
- Department of Laboratory Medicine, Seoul National University Hospital, Korea
| | - So Yeon Kim
- Department of Laboratory Medicine, National Medical Center, Korea
| | - Suhnggwon Kim
- Department of Internal Medicine, Seoul National University Hospital, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Rios DR, Fernandes AP, Carvalho MG, Figueiredo RC, Guimarães DA, Reis DR, Simões e Silva AC, Gomes KB, Dusse LM. Hemodialysis vascular access thrombosis: The role of factor V Leiden, prothrombin gene mutation and ABO blood groups. Clin Chim Acta 2011; 412:425-9. [DOI: 10.1016/j.cca.2010.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 10/27/2010] [Accepted: 11/01/2010] [Indexed: 12/01/2022]
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