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Open Access Green as soon as Postprint is submitted to ZB.
Antibodies to platelet factor 4-heparin complex and outcome in hemodialysis patients with diabetes.
Clin. J. Am. Soc. Nephrol. 5, 874-881 (2010)
BACKGROUND AND OBJECTIVES: Hemodialysis patients with type 2 diabetes exhibit an excessive cardiovascular risk and regularly receive heparin. We tested whether antibodies to the platelet factor 4-heparin complex (PF4-H-AB) contribute to outcome. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In 1255 hemodialysis patients with type 2 diabetes, the German Diabetes Dialysis Study evaluated the effect of atorvastatin (20 mg/d) versus placebo. In a post hoc analysis, the association among PF4-H-ABs, biochemistry, and prespecified, centrally adjudicated end points (combined cardiovascular end point [CVE], all-cause mortality, sudden death, myocardial infarction, stroke) was investigated. RESULTS: During 4 years, 460 patients reached the CVE; 605 died, 159 of sudden death. Myocardial infarction and stroke occurred in 199 and 97 patients, respectively. Positive PF4-H-AB status was found in 231 (18.7%) of 1236 tested patients and was associated with lower albumin, higher C-reactive protein, and arrhythmia. In a multivariate model adjusted for demographics, comorbidities, and biochemistry, PF4-H-ABs were associated with sudden death. No significant association between PF4-H-ABs and all-cause mortality, myocardial infarction, stroke, or the CVE was observed. Detecting an interaction between acetylsalicylic acid and PF4-H-ABs regarding sudden death and mortality, we found that the association between PF4-H-ABs and outcomes was restricted to patients with acetylsalicylic acid use, most likely because of indication bias. CONCLUSIONS: In hemodialysis patients who have type 2 diabetes and are treated with acetylsalicylic acid, PF4-H-ABs are associated with sudden and all-cause death. Further studies are needed to elucidate this association.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
HEPARIN-INDUCED THROMBOCYTOPENIA; FACTOR 4/HEPARIN ANTIBODIES; CARDIOVASCULAR RISK; DIALYSIS PATIENTS; RENAL-FAILURE; HEART-DISEASE; INFLAMMATION; PREVALENCE; MORTALITY; ATORVASTATIN
ISSN (print) / ISBN
1555-9041
e-ISSN
1555-905X
Quellenangaben
Volume: 5,
Issue: 5,
Pages: 874-881
Publisher
American Society of Nephrology
Non-patent literature
Publications
Reviewing status
Peer reviewed
Institute(s)
Institute of Epidemiology (EPI)