Anti-PF4/Heparin Antibodies Are Associated With Arteriovenous Fistula Thrombosis In Hemodialysis Patients

Objective:we discussed the correlation between anti-PF4/heparin Ab and autologous arteriovenous fistula thrombosis in maintenance hemodialysis patients, and analyzed the risk factors of AVF thrombosis in order to provide reference to rational use of anticoagulant and improve the life quality of end-stage renal patients.Methods:59cases were selected from Shangdong Provincal Hospital blood purification center dialysis patients with autogenous arteriovenous fistula.They accedpted regular hemodialysis therapy during2010-3—2011-11. The demographic characteristics as follows:32were male,27female, including26cases of chronic glomerulonephritis, benign renal arterial sclerosis14cases,12cases of diabetic nephropathy, obstructive nephropathy3cases, polycystic kidney2cases, the other2cases. Patients with serious heart, brain, liver comorbidities and hemorrhagic diseases should be excluded. Patients dialysised2-3times a week, each time4hours, Patients received unfractionated heparin or low molecular weight heparin individually during each dialysis treatment. All patients gave informed consent to the study.Serum samples were collected before each dialysis session from the fistula.IgG-H/PF4ELISA kit was used to determine serum anti-PF4/heparin Ab Correlated index of patients were recorded. For statistical analysis, SPSS17.0 statistical software was employed.Result:(1)Anti-PF4/H antibody positive rare was high up to37.3%in arteriovenous fistula patients;(2)Twenty patients had AVF thrombosis.The odds ratio for AVF thrombosis was3.11(95%CI1.01-9.57) for anti-PF4/heparin Ab-positive patients;(3)The ratio of unfractionated heparin and the incidence of fistula thrombosis were significantly higher in positive group compared with that in negative group (P<0.05);(4)The percentage of diabetic patients in positive group is higher than in negative group,but no significant difference in two grows;(5)There were no significant differences in sex, age, blood pressure, fistula using time, platelet count, hemoglobin, albumin, cholesterol, triglycerides, calcium, phosphorus, PTH, Kt/V between anti-PF4/heparin Ab positive and negative group (P>0.05).Conclusion:Unfractionated heparin is more easily to lead to anti-PF4/H Ab than low molecular weight heparin. Anti-PF4/H Ab may be a risk factor of AVF thrombosis. It can be used as a predictor in the development of fistula thrombosis.