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-β2-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.

Conley CL, Hartmann RC: A hemorrhagic disorder caused by circulating anticoagulants in patients with disseminated lupus erythematosus. J Lab Clin Med 1952;31:621–622.
Bowie EJW, Thompson JH, Pascui CA, Owen CA: Thrombosis in systemic lupus erythematosus despite circulating anticoagulants. J Lab Clin Med 1963;62:416–430.
Vermlen J, Arnout J: Is the antiphospholipid syndrome caused by antibodies directed against physiologically relevant phospholipid-protein complexes? J Lab Clin Med 1992;120:10–12.
Hunt JE, McNeil HP, Morgan GJ, Crameri RM, Krilis SA: A phospholipid-beta-2-glycoprotein I complex is an antigen for anticardiolipin antibodies occcuring in autoimmune disease but not with infection. Lupus 1992;1:83–90.
Blank M, Faden D, Tincani A, Kopolovic J, Goldberg I, Gilburd B, Allegri F, Balestrieri G, Valesini G, Shoenfeld Y: Immunization with anticardiolipin cofactor (beta-2-glycoprotein I) induces experimental antiphospholipid syndrome in naive mice. J Autoimmun 1994;7:441–455.
Smirnov M, Triplett DT, Comp PC, Esmon NL, Esmon CT: Role of phosphatidylethanolamine in inhibition of activated protein C activity by antiphospholipid antibodies. J Clin Invest 1995;9:309–316.
Lin R, Ehnder L: Acquired activated protein C resistance caused by factor Va antibody: A possible mechanism of increased thrombosis in the antiphospholipid antibody syndrome. Blood 1994;84(suppl):83A.
Oosting JD, Derksen RH, Bobbink IW, Hackeng TM, Bouma BN, De Groot PG: Antiphospholipid antibodies directed against a combination of phospholipids with prothrombin, protein C or protein S: An explanation for their pathogenic mechanism? Blood 1993;81:2618–2625.
Funauchi M, Hamada K, Enomoto H, Ikoma S, Ohno M, Kinoshita K, Horiuchi A: Characteristics of the clinical findings in patients with idiopathic thrombocytopenic purpura who are positive for antiphospholipid antibodies. Intern Med 1997;36:882–885.
Exner T, Triplett DA, Taberner D, Machin SJ: Guidelines for testing and revised criteria for lupus anticoagulants. SSC Subcommittee for the Standardization of Lupus Anticoagulant 1991;65:320–322.
Trent K, Neustater BR, Lottenberg R: Chronic relapsing thrombotic thrombocytopenic purpura and antiphospholipid antibodies. Am J Hematol 1997;54:155–159.
Rauch J, Janoff AS: Antibodies against phospholipids other than cardiolipin: Potential roles for both phospholipid and protein. Lupus 1996;5:498–502.
Atsumi T, Khamashta MA, Amengual O, Donohoe S, Mackie I, Ichikawa K, Koike T, Hughes GR: Binding of anticardiolipin antibodies to protein C via β2-glycoprotein-1: A possible mechanism in the inhibitory effect of antiphospholipid antibodies on the protein C system. Clin Exp Immunol 1998;112:325–333.
Roubey RAS: Autoantibodies to phospholipid-binding plasma proteins: A new view of lupus anticoagulants and other antiphospholipid antibodies. Blood 1994;84:2854–2867.
Hunt JE, Simpson RJ, Krills SA: Identification of beta-2-glycoprotein-1 critical for lipid binding and anticardiolipin cofactor activity. Proc Natl Acad Sci USA 1993;90:2141–2145.
Gharavi AF, Sammaritano LR, Wen J, Elkon KB: Induction of antiphospholipid autoantibodies by immunization with beta-2-glycoprotein-1. J Clin Invest 1992;90:1105–1109.
Matsuura E, Igarashi Y, Fujimoto M, Suzuki T, Sumide T, Yasuda T, Koike T: Heterogeneity of anticardiolipin antibodies defined by the cardiolipin factor. J Immunol 1992;148:3885–3891.
Triplett DA: Coagulation assays for the lupus anticoagulant: Review and critique of the current methodology. Stroke 1992;23(suppl l):11–14.
Schved JF, Dupuy-Fons C, Biron C, Quere I, Janbon C: A prospective epidemiological study on the occurrence of antiphospholipid antibody: The Montpellier Antiphospholipid (MAP) Study. Haemostasis 1994;24:175–182.
Levy PJ, Gonzalez MF, Hornung CA, Chang WWW, Haynes JL, Rush DS: A prospective evaluation of atherosclerosis risk factors and hypercoagulability in young adults with premature atherosclerosis. J Vasc Surg 1996;23:36–43.
Taylor LM, Chitwood RW, Dalmann RL, Sexton G, Goodnight SH, Porter JM: Antiphospholipid antibodies in vascular surgery patients. A cross-sectional study. Ann Surg 1994;220:544–550.
Gronhagen-Riska C, Teppo AM, Helanetra A, Honkanen E, Julkunen H: Raised concentrations of antibodies to cardiolipin in patients receiving dialysis. BMJ 1990;300:1696–1697.
Kirschbaum B, Mullinax F, Curry N: Association between anticardiolipin antibody and frequent clotting problems in hemodialysis (abstract). J Am Soc Nephrol 1991;2:332.
Garcia-Martin F, De Arriba G, Carrasoca T, Moldenhauer F, Martin-Escobar E, Val J, Saiz F: Anticardiolipin antibodies and lupus anticoagulant in end-stage renal disease. Nephrol Dial Transplant 1991;6:543–547.
Bala Subramania V, Smith D, McMillan MA: Anticardiolipin antibodies in long-term dialysis patients (abstract). Nephrol Dial Transplant 1992;7:459.
Sitter T, Schiffl H: Anticardiolipin antibodies in patients on regular hemodialysis: An epiphenomenon? Nephron 1993;64:655–656 (letter).
Westerman EM, Miles JM, Backonja M, Soundstrom WR: Neuropathologic findings in multi-infarct dementia associated with anticardiolipin antibody. Evidence for endothelial injury as the primary event. Arthritis Rheum 1992;35:1038–1041.
Cockwell P, Tse WY, Savage CO: Activation of endothelial cells in thrombosis and vasculitis. Scand J Rheumatol 1997;26:145–150.
Del-Pappa N, Raschi E, Catelli L, Khamashtra MA, Ichikawa K, Tincani A, Balestrieri G, Meroni PL: Endothelial cells as a target for antiphospholipid antibodies: Role of anti-β2-glycoprotein I antibodies. Am J Reprod Immunol 1997;38:212–227.
Vaarala O, Alfthan G, Jauhiainen M: Cross-reaction between antibodies to oxidized LDL and to cardiolipin in systemic lupus erythematosus. Lancet 1993;341:923–925.
George J, Blank M, Hojnik M, Bar-Meir E, Koike T, Matsuura E, Lorber M, Aviram M, Shoenfeld Y: Oxidized LDL but not LDL aggravates the manifestations of experimental antiphospholipid syndrome. Clin Exp Immunol 1997;108:227–233.
Kabakov AE, Tertov VV, Saenko VA, Poverenny AM, Orekhov AN: The atherogenic effect of lupus sera: Systemic lupus erythematosus derived immune complexes stimulate the accumulation of cholesterol in cultured smooth muscle cells from human aorta. Clin Immunol Immunopathol 1992;63:214–220.
Horkko S, Miller E, Dudl E, Reaven P, Curtiss LK, Zvifler NJ, Terkeltaub R, Pieranegil SS, Branch DW, Palinski W, Witztum JL: Antiphospholipid antibodies are directed against epitopes of oxidized phospholipids. Recognition of cardiolipin by monoclonal antibodies to epitopes of oxidized low density lipoprotein. J Clin Invest 1996;98:815–825.
Amengual O, Atsumi T, Khamashta MA, Tinahones F, Hughes GR: Autoantibodies against oxidized LDL in antiphospholipid syndrome. Br J Rheumatol 1997;36:964–968.
Atsumi T, Khamashta MA, Andujar C, Leandro MJ, Ames PR, Hughes GR: Elevated plasma lipoprotein (a) level and its association with impaired fibrinolysis in patients with antiphospholipid syndrome. J Rheumatol 1998;25:69–73.
Takeya H, Tanaka Y, Suzuki K: Thrombosis and apoptosis. Jpn J Clin Pathol 1997;45:614–620.
Harris EN, Khamashata MA, Hughes GRV: Antiphospholipid antibody syndrome; in McCarty DJ, Koopman WJ (eds): Arthritis and Allied Conditions, ed 12. Philadelphia, Lea & Febiger, 1993, pp 1201–1212.
George J, Harats D, Gilburs B, Shoenfeld Y: Emerging cross-regulatory roles of immunity and autoimmunity in atherosclerosis. Immunol Res 1996;155:315–322.
Shoenfeld Y, Isenberg DA: The mosaic of autoimmunity. Immunol Today 1989;10:123–126.
Stemme S, Faber B, Holm J, Wiklund O, Witztum JL, Hansson GK: T lymphocytes from human atherosclerotic plaques recognize oxidized low density lipoprotein. Proc Natl Acad Sci USA 1995;92:3893–3897.
Frostegard J, Wu R, Giscombe R, Holm G, Lefvert AK, Nilsson J: Induction of T cell activation by oxidized low density lipoprotein. Arterioscler Thromb 1992;14:461–467.
Yla-Herttuala S, Palinski W, Butler SW, Picard S, Steinberg D, Witztum JL: Rabbit and human atherosclerotic plaques contain IgG that recognized epitopes of oxidized low density lipoprotein. Arterioscler Thromb 1994;14:32–40.
Lyons TJ: Lipoprotein glycation and its metabolic consequences. Diabetes 1992;41(suppl 2):67–73.
Wilson WA: Histocompatibility genes in antiphospholipid antibody syndrome. Lupus 1996;5:259–262.
Sebastini GD, Galeazzi M, Morozzi G, Marcolongo R: The immunogenetics of the antiphospholipid syndrome, anticardiolipin antibodies, and lupus anticoagulant. Semin Arthritis Rheum 1996;25:414–420.
Martinuzzo ME, Forastiero RR, Carreras LO: Anti–βGPI antibodies: Detection and association with thrombosis. Br J Haematol 1995;89:397–402.
Viard JP, Amoura Z, Bach JF: Association of anti-βGPI antibodies with lupus-type circulating anticoagulant and thrombosis in systemic lupus erythematosus. Am J Med 1992;82:571–574.
Nesher G, Ilany J, Rosenmann D, Abraham AS: Valvular dysfunction in antiphospholipid syndrome: Prevalence, clinical features, and treatment. Semin Arthritis Rheum 1997;27:27–35.
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