Study Of-acl Antibodies In Relation To Vascular Access Thrombosis In Children On Maintenance Hd:

Fatma Mohammed Youssef Ali

This study with of 30 children with chronic renal failure on regular hemodialysis through an arteriovenous fistula, attending to the Pediatric Nephrology and Hemodialysis Unit, Children Hospital, Cairo University, from January 2005 to March 2006. In addition to 20 control children. The diagnosis was made by the detailed history and thorough physical examination, and confirmed by the specified laboratory tests.Based on the study design, the children were divided into two groups; group I included 30 children patients with chronic renal failure and on regular hemodialysis, and group II included 20 normal children.The age of the 30 studied patients ranged between 5 to 16 years, with a mean of 10.183±2.969 years, and a median of 10 years. Among them, 17 (56.7%) were males, and 13 (43.3%) were females, with a male to female ratio of 1.3:1.The weight of the studied patients ranged between 10.5 to 43.5 Kg, with a mean of 22.406±6.955 Kg, and a median of 21.25 Kg, and the head circumference ranged between 47.5 to 56.0 cm, with a mean of 51.816±2.517 cm, and a median of 51.75 cm. these figures showed that diseased children had decreased weight.Duration of illness ranged between 24 months (2 years) and 60 months (5 years), with a mean of 39.433±10.135 months, and a median of 36 months, and the duration of hemodialysis ranged between 10 months (<1 years) and 48 months (4 years), with a mean of 26.600±10.081 months, and a median of 27 months.Twenty out of the studied 30 patients (66.7%) had an associated disease, while the remaining 10 patients (33.3%) had no associated diseases. Some associated diseases were directly related to the chronic state of the patients, such as: uremic cardiomyopathy, short stature, anemia, and stunted growth. While other were not related such as; squint, and myopia.The blood pressure of the studied patients were measured before and after dialysis. Before dialysis, The mean value of systolic blood pressure before dialysis was 126±9.32 mmHg, with a range of 100 to 140 mmHg, and the mean value of diastolic blood pressure before dialysis was 82.166±7.5 mmHg, with a range of 60 to 90 mmHg. These figures confirmed that children with ESRD on regular HD are hypertensive.After dialysis: the mean value of systolic blood pressure after dialysis was 112.833±10.8 mmHg, with a range of 80 to 130 mmHg, and the mean value of diastolic blood pressure after dialysis was 74.66±8.4 mmHg, with a range of 50 to 85 mmHg. Hemodialysis corrected hypertensive state.The hemoglobin value ranged between 8 to 14.2 g/dl, with a mean value of 10.4±1.5 g/dl and a median of 10.3 g/dl, and the hematocrite value ranged between 5.10 to 39.7 L%, with a mean value of 28.6±6.2 L% and a median of 28.85 L%. comparing both figures with the control group highly stsistically significant differences were found indicating aneamia in children on regular HD.The urea level ranged between 8 to 136 mg/dl, with a mean value of 27.346±21.865 mg/dl and a median of 22.5 mg/dl, and the creatinine level ranged between 1 to 8.7 mg/dl, with a mean value of 3.236±1.775 mg/dl and a median of 2.7 mg/dl. A highly statistically significant difference was found between diseased and healthy children.The anticardiolipin antibody (IgG-aCL) titre in the studied patients ranged between 2.9 to 11.80 GPL U/mL, with a mean value of 6.976±2.138 U/mL and a median of 6.95 U/mL, and the IgG-aCL titre in the studied controls ranged between 2.1 to 5.7 U/mL, with a mean value of 3.595±1.077 U/mL and a median of 3.35 U/mL. A highly statistically significant difference was found between both groups.Except for hemoglobin, all stidued variables showed no statistically significant differences when corelated with the anticardiolipin antibody titre.Thrombosis of the arteriovenous fistula occurred in 10 patients (33.3%) out of the studied 30 patients.Classification of patients according to anticardiolipin antibody level showed that there were no statistically significant differences between normal and elevated IgG-aCL titre including, age, sex, duration of illnesds, duration of hemodialysis, weight, head circumference, hemoglobin, hematocrite, urea, creatinine.The incidence of vascular thrombosis for those with normal and elevated IgG-aCL (anticardiolipin antibody) titres showed that in patients with normal IgG-aCL; 2 patients out of 8 (2/8, 25%) had vascular thrombosis, and that in patients with elevated IgG-aCL; 8 patients out of 22 (8/22, 36.4%) had vascular thrombosis. No statistically significant difference was found between these two groups.Classification of patients according to occurrence of Thrombosis showed that there were no statistically significant differences between normal and elevated IgG-aCL titre including, age, sex, duration of illnesds, duration of hemodialysis, weight, head circumference, hemoglobin, hematocrite, urea, creatinine.The level of IgG-aCL in patiuents with and without thrombosis showed that; in patients without thrombosis; the IgG-aCL titres ranged from 2.9 to 11.8 GPL U/mL, with a mean of 6.650±2.217 GPL U/mL, and a median of 6.45 GPL U/mL. In patients with thrombosis; the IgG-aCL titres ranged from 3.8 to 10.2 GPL U/mL, with a mean of 7.630±1.907 GPL U/mL, and a median of 8 GPL U/mL. No statistically significant difference was found between these two groups.All the previous data proved that in spite of the elevate IgG-aCL levels in children with ESRD on maintenance HD, it has no significant relation to the occurrence of vascular access thrombosis.Results at the end of the study showed that two patients (6.7%) died, 2 patients (6.7%) underwent renal transplantation, and the remaining 26 patients (86.7%) continued hemodialysis.