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Anti-platelet factor 4/heparin antibody is associated with progression of peripheral arterial disease in hemodialysis patients

  • Nephrology - Original Paper
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Abstract

Background

Heparin therapy may induce anti-platelet factor 4/heparin antibody (PF4-H Ab). Hemodialysis patients receive scheduled heparin and are at a risk of developing PF4-H Ab. Hemodialysis patients are also at a high risk of peripheral arterial disease (PAD). This study examines whether chronic PF4-H Ab exposure contributes to the progression of PAD measured by ankle brachial index (ABI) in hemodialysis patients.

Materials and methods

A total of 71 hemodialysis patients were enrolled, and the association between clinical, biochemical parameters and ABI after 3 years was studied. PF4-H Ab was evaluated by ELISA, and patients with titer ≥0.4 were taken as having PF4-H Ab.

Results

Mean ABI was 1.04 ± 0.18 at baseline and 1.01 ± 0.17 after 3 years. Mean ΔABI (change in ABI after 3 years) was −0.04 ± 0.13. PF4-H Ab was positive in 26 patients. PF4-H Ab was not related to hemodialysis duration, DM history, smoking and age. Platelet count showed no correlation with PF4-H Ab. However, there was significance in ΔABI between PF4-H Ab-positive and PF4-H Ab-negative patients (p = 0.002). ΔABI was negatively correlated with PF4-H Ab and 3-year averaged serum Ca × P only (β = −0.378, p = 0.001; β = −0.263, p = 0.018, respectively). However, in PF4-H Ab-positive patients, the extent of ΔABI did not correlate with PF4-H Ab titers (r = −0.021, p = 0.921).

Conclusions

PF4-H Ab positivity, along with high levels of serum Ca × P, played a potential role in the progression of PAD over time.

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Author notes

    Authors and Affiliations

    1. Division of Cardiology, Tainan Sinlau Hospital, Tainan, Taiwan, Republic of China

      Yen-Hsun Chen

    2. Department of Biotechnology, Southern Taiwan University, Tainan, Taiwan, Republic of China

      Kao-Chang Lin

    3. Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan, Republic of China

      Kao-Chang Lin

    4. Division of Nephrology, Department of Internal Medicine, Tainan Sinlau Hospital, No. 57, 1 Sec., Dongmen Rd., Tainan, Taiwan, Republic of China

      Yueh-Feng Tsai, Lai-King Yu, Li-Hsueh Huang & Chien-An Chen

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    1. Yen-Hsun Chen
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    Correspondence to Chien-An Chen.

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    All authors declare no conflict of interest.

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    Yen-Hsun Chen and Kao-Chang Lin contributed equally to this work.

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    Chen, YH., Lin, KC., Tsai, YF. et al. Anti-platelet factor 4/heparin antibody is associated with progression of peripheral arterial disease in hemodialysis patients. Int Urol Nephrol 47, 1565–1570 (2015). https://doi.org/10.1007/s11255-015-1056-3

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    • DOI: https://doi.org/10.1007/s11255-015-1056-3

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