Correlation between Antiphospholipid Antibodies and the Intima Media Thickness in Vascular access Thrombosis in Egyptian Patients with Systemic Lupus Erythematosus on Regular Hemodialysis

摘要

Background:Anticardiolipin antibody is associated with increased risk of vascular access thrombosis in hemodialysis (HD) patients. Thus the thrombosis risk factors should be evaluated extensively and regularly and treated aggressively in every patient with systemic lupus erythematosus on regular hemodialysis. Aimofthework:Assessment the occurrence of vascular access thrombosis in SLE patients on regular hemodialysis, and its relation to SLE disease activity and correlation of antiphospholipid antibodies to occurrence of vascular access thrombosis. Patientsandmethods:This cross-sectional study included 50 Egyptian patients with SLE on HD, who had either an arterio-venous (AV) graft or naive AV fistula as vascular access, and were not on anticoagulation treatment, were recruited from dialysis unite of Al Azhar university Hospital new Damietta, hemodialysis unite of Al Azhar university Hospital Assuit, Kafr saad general Hospital hemodialysis unite, and other specialized Hemodialysis unites in Damietta; during the period from November 2013 to October 2014; patients were divided in to two groups according to presence or absence of vascular thrombosis;GroupA: Included thirty-four patients with SLE on regular hemodialysis with previous thrombosis (ThromboticLupus).GroupB: Included sixteen patients with SLE on regular hemodialysis with no previous thrombosis and/or fetal loss (Non-ThromboticLupus).Also therewasControlgroupwhich included 20 patients with end stage renal disease (ESRD) on regular hemodialysis without SLE. All the studied subjects underwent full history taking. detailed clinical examination, measurement of anti-ds DNA, ANA, anticardiolipin IgG & IgM and lupus anticoagulant in addition to CBC, PT, PTT, kidney, liver function tests and duplex on A-V fistula with measurement of intima media thickness. Univariate. Results:The results showed that 68% of SLE patients had previous thrombosis, and 32% of SLE patients had no thrombosis. there were a highly statistically significant difference between the three groups as regard ACL IgG & IgM, lupus anticoagulant, ANA, Anti-ds DNA and duplex on A-V fistula (P < 0.01) as it was highest in group A and lowest value detected in group B. there were a highly statistically significant positive correlations between ANA and PTT and between ACL IgG and ACL IgM and lupus anticoagulant (P < 0.01). Conclusions: The levels of Anti cardiolipin IgG, IgM, lupus anticoagulant were higher in SLE patients on regular hemodialysis with vascular access thrombosis with high correlation to intima media thickness of the vascular access. And the occurrence of thrombosis is highly related to SLE disease activity.