A large prospective survey of anti-cardiolipin antibodies in chronic hemodialysis patients.

We prospectively measured anti-cardiolipin antibody (ACLA) levels in 230 chronic hemodialysis (HD) patients over a 2-year period. Twenty-nine percent of HD-patients were found to have elevated IgG-ACLA titers. Males were more likely to have elevated IgG-ACLA titers. Elevated IgG-ACLA titers correlated with shortened AVG survival in HD-patients (mean of 156 vs. 238 days, p<0.05). There was no statistically significant correlation with access survival in AVF-patients. There seemed to be a higher mean IgG-ACLA titer in diabetics but they did not have statistically significant shorter angioaccess survival times. By logistic regression analysis, only IgG-ACLA positivity was predictive of premature angioaccess failure (p<0.05). In a selected subset of 16 patients with frequent angioaccess (AVG) failure and elevated IgG-ACLA levels, coumadin, titrated to an INR of 2 - 3, was found to produce a small (though statistically significant) prolongation of AVG survival.