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ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 3  |  Page : 916-921

ADAMTS13 plasma level in maintenance hemodialysis patients: its relation to vascular access thrombosis


1 Department of Internal Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Nephrology, Shebin El Kom Teaching Hospital, Shebin El Kom, Egypt

Correspondence Address:
Sara M H. Kashkoush
Department of Nephrology, Shebin El Kom Teaching Hospital, Shebin El Kom, Menofuia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_730_17

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Objective The aim of this study was to evaluate ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) plasma level in patients under maintenance hemodialysis (HD) to determine its relation in the occurrence of vascular access thrombosis (VAT) in such patients. Background An increased thrombotic tendency is an important cause of complications in patients on chronic HD leading to thrombosis of the vascular access. VAT remains the main problem in vascular access for HD. Hypercoagulability in patients on chronic HD can be caused by a variety of factors, mainly consisting of platelet abnormalities and plasma factor abnormalities. Some of the plasma factor abnormalities are ADAMTS13 abnormalities. ADAMTS13 deficiency and/or the presence of antibodies against this enzyme may increase ultra large von Willebrand factor plasma levels, favoring the occurrence of thrombosis in small vessels. Materials and methods This case–control study was conducted on 60 patients on HD for more than 6 months classified into two groups: group I included 30 patients with VAT, and group II included 30 patients without VAT. Moreover, 20 healthy individuals served as a control group. History taking, clinical examination, and investigation were done. Results Mean ADAMTS13 serum level was found to be lower in HD groups of patients, with highly significant decrease in serum ADAMTS13 levels in group I (131.67 ng/ml) compared with group II (310.37 ng/ml) and group III (605.35 ng/ml), with P value of less than 0.001. A cut-off level at 200 ng/ml was accurate (95.00%) for occurrence of VAT in group I patients with sensitivity of 96.67%, specificity of 93.33%, positive predictive value of 93.55% and negative predictive value of 96.55%. Conclusion Low ADAMTS13 serum level was associated with occurrence of VAT.


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