Underestimated effect of antiphospholipid antibodies on arteriovenous fistula maturation in hemodialysis patients

Abstract

Background: Arteriovenous fistula delay or absence of maturation is a common problem in hemodialysis. The prevalence of antiphospholipid antibody is higher among hemodialysis patients compared to the general population and is inconsistently associated with arteriovenous fistula thrombosis or stenosis. However, the effect of antiphospholipid antibodies on delayed or absence of maturation of the arteriovenous fistula has never been studied. Methods: We retrospectively identified 103 hemodialyzed patients with arteriovenous fistula whether used or not. We collected the clinical and biological data potentially involved in arteriovenous fistula maturation and investigated the association between antiphospholipid antibody positivity and arteriovenous fistula maturation failure according to KDOQI guidelines. Results: In our cohort, the prevalence of arteriovenous fistula maturation failure was of 45.8%. The prevalence of antiphospholipid syndrome was of 7.8 %, whereas only 10.7% of patients fulfilled only antiphospholipid laboratory criteria. The persistent positivity of antiphospholipid antibody was a risk factor for arteriovenous fistula maturation failure. In multivariate analysis, this association was independent of stenosis. Conclusions: To our knowledge, we report for the first time, a statistically significant association between arteriovenous fistula maturation failure, antiphospholipid antibody persistent positivity and antiphospholipid syndrome. This association was independent of arteriovenous stenosis. Our data suggests a potential non-stenotic and/or non-thrombotic mechanism of antiphospholipid antibody related arteriovenous fistula maturation failure in hemodialysis patients.

Antiphospholipid Antibodies Associated with Native Arteriovenous Fistula Complications in Hemodialysis Patients: A Comprehensive Review of the Literature

“…Interestingly, this subgroup of patients had significantly higher maturation failure rates compared to aPL negative patients. This study was designed to assess AVF thrombosis or stenosis, only during the AVF maturation period (i.e., a 6-week period) [ 48 ].…”

“…This association was independent of stenosis and intimal hyperplasia in a multivariate analysis. Interestingly, we reported that patients with a fluctuation aPL profiles also have a significant higher prevalence of AVF maturation failure [ 48 ]. We hypothesized that aPL might cause AVF maturation failure, possibly through endothelial dysfunction leading to an impaired vascular remodeling capability without stenosis [ 7 , 59 , 60 ].…”