Heparin-platelet factor 4 antibodies as a predictor of hypercoagulability in pediatric patients on chronic hemodialysis

Background Heparin, a widely utilized anticoagulant in hemodialysis (HD), is known to sometimes trigger the release of heparin-platelet factor 4 (HPF4) antibodies. These antibodies have been implicated in the development of heparin-induced thrombocytopenia (HIT) and thrombotic complications. Aim To detect the prevalence and diagnostic performance of HPF4 antibodies in chronic kidney disease (CKD) patients undergoing HD and their association with thrombocytopenia and thrombosis, to be used as a marker of hypercoagulability during HD. Subjects and methods This cross-sectional study comprised 80 pediatric patients with chronic kidney disease divided into two groups: Group A included patients on maintenance hemodialysis, while Group B included patients on conservative treatment. ELISA was used for determination of HPF4 antibodies. Results Prevalence of HPF4 antibodies in group A patients was 72.5% and was significantly higher when compared with group B patients (5%) with P-value of 0.001. The mean HPF4 optical density value was significantly greater in group A (0.61 ± 0.57) than in group B (0.04 ± 0.05) with P-value of 0.001. Incidence of vascular access thrombosis events was significantly greater in HPF4 positive-patients than in HPF4 negative-patients, with P-value of 0.001. ROC analysis showed excellent performance of HPF4 antibodies (AUC = 0.950) and good performance of HPF4 optical density (AUC = 0.746) for detecting hypercoagulability (both P -value < 0.001). Conclusion This study demonstrates that HPF4 antibodies are prevalent in patients with CKD undergoing maintenance hemodialysis. Detection of the HPF4 antibodies can predict the occurrence of thromboembolic events and might be used as a marker of hypercoagulability in this patient cohort.