Increased mortality in hemodialysis patients having specific antibodies to the platelet factor 4-heparin complex

M. Carrier; M. A. Rodger; D. Fergusson; S. Doucette; M. J. Kovacs; J. Moore; J. G. Kelton; G. A. Knoll

doi:10.1038/sj.ki.5002631

Increased mortality in hemodialysis patients having specific antibodies to the platelet factor 4-heparin complex

M. Carrier, M. A. Rodger, D. Fergusson, S. Doucette, M. J. Kovacs, J. Moore, J. G. Kelton, G. A. Knoll

Research output: Contribution to journal › Article › peer-review

29 Citations (Scopus)

Abstract

Heparin-induced thrombocytopenia is a serious complication of heparin therapy that can lead to thromboembolism, cardiovascular events, and death. Hemodialysis patients are repeatedly exposed to heparin and are at risk for developing antibodies to the platelet factor 4-heparin (PF4-H) complex. We sought to determine the association between PF4-H antibodies and mortality in a prospective cohort of 419 asymptomatic hemodialysis patients. Pre-dialysis blood samples were screened for nonspecific PF4-H antibodies, and all positive and indeterminate samples were subsequently tested using immunoglobulin (Ig)G-specific PF4-H and platelet serotonin-release assays. During a median follow-up of 2.5 years there were 129 all-cause deaths. After controlling for potential confounding variables, the relative risk of death was significantly increased for patients with IgG-specific PF4-H antibodies and further elevated with an indeterminate serotonin-release assay. Our study suggests that IgG-specific PF4-H antibody formation is associated with increased mortality in hemodialysis patients.

Original language	English
Pages (from-to)	213-219
Number of pages	7
Journal	Kidney International
Volume	73
Issue number	2
DOIs	https://doi.org/10.1038/sj.ki.5002631
Publication status	Published - Jan 10 2008
Externally published	Yes

Bibliographical note

Funding Information:
This work was supported by grant R05-28 from the Physician’ Services Incorporated Foundation. MAR is a recipient of the Maureen Andrew New Investigator Award from the Heart and Stroke Foundation of Canada. None of the authors have any conflict of interest to disclose. Dr GA Knoll had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. We thank the staff and patients from the dialysis units who participated in this study.

ASJC Scopus Subject Areas

Nephrology

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Cite this

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title = "Increased mortality in hemodialysis patients having specific antibodies to the platelet factor 4-heparin complex",

abstract = "Heparin-induced thrombocytopenia is a serious complication of heparin therapy that can lead to thromboembolism, cardiovascular events, and death. Hemodialysis patients are repeatedly exposed to heparin and are at risk for developing antibodies to the platelet factor 4-heparin (PF4-H) complex. We sought to determine the association between PF4-H antibodies and mortality in a prospective cohort of 419 asymptomatic hemodialysis patients. Pre-dialysis blood samples were screened for nonspecific PF4-H antibodies, and all positive and indeterminate samples were subsequently tested using immunoglobulin (Ig)G-specific PF4-H and platelet serotonin-release assays. During a median follow-up of 2.5 years there were 129 all-cause deaths. After controlling for potential confounding variables, the relative risk of death was significantly increased for patients with IgG-specific PF4-H antibodies and further elevated with an indeterminate serotonin-release assay. Our study suggests that IgG-specific PF4-H antibody formation is associated with increased mortality in hemodialysis patients.",

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note = "Funding Information: This work was supported by grant R05-28 from the Physician{\textquoteright} Services Incorporated Foundation. MAR is a recipient of the Maureen Andrew New Investigator Award from the Heart and Stroke Foundation of Canada. None of the authors have any conflict of interest to disclose. Dr GA Knoll had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. We thank the staff and patients from the dialysis units who participated in this study.",

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AU - Kelton, J. G.

AU - Knoll, G. A.

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N2 - Heparin-induced thrombocytopenia is a serious complication of heparin therapy that can lead to thromboembolism, cardiovascular events, and death. Hemodialysis patients are repeatedly exposed to heparin and are at risk for developing antibodies to the platelet factor 4-heparin (PF4-H) complex. We sought to determine the association between PF4-H antibodies and mortality in a prospective cohort of 419 asymptomatic hemodialysis patients. Pre-dialysis blood samples were screened for nonspecific PF4-H antibodies, and all positive and indeterminate samples were subsequently tested using immunoglobulin (Ig)G-specific PF4-H and platelet serotonin-release assays. During a median follow-up of 2.5 years there were 129 all-cause deaths. After controlling for potential confounding variables, the relative risk of death was significantly increased for patients with IgG-specific PF4-H antibodies and further elevated with an indeterminate serotonin-release assay. Our study suggests that IgG-specific PF4-H antibody formation is associated with increased mortality in hemodialysis patients.

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Increased mortality in hemodialysis patients having specific antibodies to the platelet factor 4-heparin complex

Abstract

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ASJC Scopus Subject Areas

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