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      Association of Anticardiolipin Antibodies with Vascular Access Occlusion in Hemodialysis Patients: Cause or Effect?


      S. Karger AG

      Anticardiolipin antibody, Antiphospholipid antibody, Vascular occlusion, Arteriovenous access, Hemodialysis

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          Background: Uremic patients on hemodialysis (HD) often display occlusive disorders despite their uremic thromboasthenia. The role of anticardiolipin antibodies (aCL) and the recently identified anti-β<sub>2</sub>-glycoprotein I antibodies (aβGPI) in these phenomena is unknown. Methods: The prevalence of IgG and IgM aCL and aβGPI was documented in 54 HD patients and 19 nondialyzed patients with chronic renal failure (CRF). The HD patients were further divided into arteriovenous (AV) access occluders and nonoccluders. Results: HD patients had a higher mean IgG aCL level than CRF patients (14.68 ± 3 vs. 2.96 ± 1 IU/ml, respectively, p < 0.0007). IgM aCL did not differ significantly. AV access occluders had a higher mean IgG and IgM aCL levels than nonoccluders (24.47 and 8.39 IU/ml in occluders vs. 8.45 and 3.59 IU/ml in nonoccluders, p < 0.0226 and p < 0.05, respectively). IgM and IgG aβGPI antibody levels were below the cutoff point and did not differ significantly between the various groups. Cardiovascular episodes were not correlated with the titer of aCL or aβGPI. Conclusion: These results indicate that HD, especially in patients with recurrent access occlusion episodes, is associated with elevated levels of IgG aCL, and that IgG aCL level may predict the occlusive status of HD patients.

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          Most cited references 4

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          The mosaic of autoimmunity.

          The term 'autoimmune' is applied to a wide spectrum of diseases, which, although they may differ in pathology, share many factors. In their review, portrayed as a mosaic, Yehuda Shoenfeld and David Isenberg illustrate the complexity of these conditions, outlining the many pieces, genetic, hormonal, immunological and environmental that contribute to auto-immunity, and show how their varying combinations lead to diverse diseases.
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            Immunization with anticardiolipin cofactor (beta-2-glycoprotein I) induces experimental antiphospholipid syndrome in naive mice.

             D Faden,  M. Blank,  A Tincani (1994)
            Beta-2-GPI is a 50 kDa glycoprotein which is known to be a serum co-factor, with a role in determining the binding of pathogenic anticardiolipin antibodies to phospholipids. Immunization of naive mice with beta-2-GPI resulted in elevated levels of antibodies directed against negatively charged phospholipids (cardiolipin, phosphotidylserine, phosphatidylinositol). The presence of increased titres of antiphospholipid antibodies in the sera of the mice was later followed by prolonged activated partial thromboplastin time (APTT), thrombocytopenia, and when the mice were mated, by a high percentage of fetal resorptions in the uterus. These data point to the ability of beta-2-GPI to induce pathogenic anti-cardiolipin antibodies following active immunization.
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              Crossreaction between antibodies to oxidised low-density lipoprotein and to cardiolipin in systemic lupus erythematosus

               O Vaarala,  K Aho,  T Palosuo (1993)

                Author and article information

                S. Karger AG
                December 2000
                01 December 2000
                : 86
                : 4
                : 447-454
                Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
                45833 Nephron 2000;86:447–454
                © 2000 S. Karger AG, Basel

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                Figures: 3, Tables: 5, References: 48, Pages: 8
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