title: Association between antiphospholipid antibodies and all-cause mortality among end-stage renal disease patients with and without SLE: a retrospective cohort study.
abstract: OBJECTIVE
  To investigate the association between the presence of aPL and/or LA and all-cause mortality among end-stage renal disease (ESRD) patients with and without SLE.
  
  
  METHODS
  We included ESRD patients >18 years old followed at an urban tertiary care centre between 1 January 2006 and 31 January 2014 who had aPL measured at least once after initiating haemodialysis. All SLE patients met ACR/SLICC criteria. APL/LA+ was defined as aCL IgG or IgM >40 IU, anti-β2glycoprotein1 IgG or IgM >40 IU or LA+. Deaths as at 31 January 2014 were captured in the linked National Death Index data. Time to death was defined from the first aPL measurement.
  
  
  RESULTS
  We included 34 SLE ESRD and 64 non-SLE ESRD patients; 30 patients died during the study period. SLE ESRD patients were younger [40.4 (12.5) vs 51.9 (18.1) years, P = 0.001] and more were women (88.2% vs 54.7%, P < 0.001) vs non-SLE ESRD patients. The frequency of aPL/LA+ was 24% in SLE and 13% in non-SLE ESRD (P = 0.16). Median (inter-quartile range) follow-up time was 1.6 (0.3-3.5) years in SLE and 1.4 (0.4-3.2) years in non-SLE, P = 0.74. The adjusted hazard ratio (HR) for all-cause mortality for SLE patients who were aPL/LA+ vs aPL/LA- was 9.93 (95% CI 1.33, 74.19); the adjusted HR for non-SLE aPL/LA+ vs aPL/LA- was 0.77 (95% CI 0.14, 4.29).
  
  
  CONCLUSIONS
  SLE ESRD patients with aPL/LA+ had higher all-cause mortality risk than SLE ESRD patients without these antibodies, while the effects of aPL/LA on mortality were comparable among non-SLE ESRD patients.
authors.affiliation: Division of Rheumatology, Department of Medicine, abroder@montefiore.org.
authors.forename: Anna
authors.initials: A
authors.lastname: Broder
authors.affiliation: Division of Biostatistics, Department of Epidemiology and Population Health.
authors.forename: Wenzhu B
authors.initials: WB
authors.lastname: Mowrey
authors.affiliation: Division of Biostatistics, Department of Epidemiology and Population Health.
authors.forename: Mimi
authors.initials: M
authors.lastname: Kim
authors.affiliation: Division of Hematology.
authors.forename: Irina
authors.initials: I
authors.lastname: Murakhovskaya
authors.affiliation: Division of Hematology.
authors.forename: Henny
authors.initials: H
authors.lastname: Billett
authors.affiliation: Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY and.
authors.forename: Joel
authors.initials: J
authors.lastname: Neugarten
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Costenbader
authors.affiliation: Division of Rheumatology, Department of Medicine.
authors.forename: Chaim
authors.initials: C
authors.lastname: Putterman
mesh_terms: D000328:Adult; D000368:Aged; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000276:immunology / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000276:immunology* / Q000401:mortality / Q000628:therapy; D008181:Lupus Nephritis / Q000150:complications / Q000276:immunology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D017152:Antibodies, Antiphospholipid
keywords: antiphospholipid antibodies; end stage; haemodialysis; lupus nephritis; renal disease; systemic lupus erythematosus