{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:36:21Z","timestamp":1785411381551,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002403","name":"Taibah University","doi-asserted-by":"publisher","award":["47-15-1108"],"award-info":[{"award-number":["47-15-1108"]}],"id":[{"id":"10.13039\/501100002403","id-type":"DOI","asserted-by":"publisher"}]},{"award":["47-15-1108"],"award-info":[{"award-number":["47-15-1108"]}],"id":[{"id":"https:\/\/ror.org\/01xv1nn60","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Elevated anticardiolipin IgG (aCL IgG) has been reported in end-stage renal disease (ESRD), but its association with specific etiologies of kidney failure remains unexplored. The unique pathophysiology of diabetic\u2013hypertensive nephropathy may be associated with a microenvironment that could potentially contribute to antiphospholipid antibody production and thrombotic complications. This study aimed to investigate whether aCL IgG elevation in hemodialysis (HD) patients is associated with combined diabetes\u2013hypertension (DM + HTN) etiology and thrombocytopenia, thereby identifying a clinically distinct potential high-risk subgroup. In this hypothesis-generating study, we focused on within-HD patient comparisons rather than healthy controls. Methods: We enrolled 242 participants: 150 healthy controls (included only to establish local reference ranges) and 92 patients with maintenance HD. The study was conducted from 01 September to 20 November 2025 in Madinah, Saudi Arabia. Serum aCL IgG was measured by chemiluminescence immunoassay (positive \u2265 12 GPL units). Comprehensive hematological and biochemical parameters were analyzed. Multivariable logistic regression identified predictors of aCL positivity. Results: In the HD cohort, 21% demonstrated aCL positivity; this represents a substantially higher rate than the 2% observed in local healthy controls (p &lt; 0.001). This elevation was not uniform across etiologies. Strikingly, 94.7% (18\/19) of aCL-positive HD patients had DM + HTN aetiology, compared with only 17.8% of aCL-negative patients (p &lt; 0.001). Thrombocytopenia was significantly more severe in aCL-positive patients (median platelets: 100 vs. 191 \u00d7 109\/L, p &lt; 0.001). In multivariable analysis, DM + HTN etiology (HTN-alone vs. DM + HTN odds ratio [OR]: 0.0013, 95% confidence interval [CI]: 0.00002\u20130.0999, p = 0.003; confirmed by Firth\u2019s penalized logistic regression sensitivity analysis, and lower platelet count (OR: 0.92 per 1 \u00d7 109\/L increase, 95% CI: 0.87\u20130.98, p = 0.006) independently predicted aCL positivity. Conclusions: These hypothesis-generating findings suggest a potential association between metabolic\u2013vascular disease and antiphospholipid immunity in ESRD. Causality cannot be inferred from this cross-sectional design. At present, routine aCL screening is not recommended outside of research protocols; prospective studies are needed to confirm these associations.<\/jats:p>","DOI":"10.3390\/jcm15093269","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:40:12Z","timestamp":1777981212000},"page":"3269","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations Between Elevated Anticardiolipin IgG, Thrombocytopenia, and Combined Diabetes\u2013Hypertension Etiology in Hemodialysis Patients"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1534-4223","authenticated-orcid":false,"given":"Hatem Q.","family":"Makhdoom","sequence":"first","affiliation":[{"name":"Clinical Laboratory Sciences Department, College of Applied Medical Sciences, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1395-9555","authenticated-orcid":false,"given":"Ibrahim","family":"Sandokji","sequence":"additional","affiliation":[{"name":"Department of Child and Women\u2019s Health, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia"},{"name":"Department of Pediatrics, Prince Mohammad Bin Abdulaziz Hospital, National Guard Health Affairs, Madinah 40740, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4649-5285","authenticated-orcid":false,"given":"Yara H.","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Regional Laboratory, Ministry of Health, Madinah P.O. Box 935, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4555-9185","authenticated-orcid":false,"given":"Khalid I.","family":"Alahmadi","sequence":"additional","affiliation":[{"name":"Regional Laboratory, Ministry of Health, Madinah P.O. Box 935, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2345-6817","authenticated-orcid":false,"given":"Mazen S.","family":"Almohammdi","sequence":"additional","affiliation":[{"name":"Regional Laboratory, Ministry of Health, Madinah P.O. Box 935, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3092-962X","authenticated-orcid":false,"given":"Bashayer A.","family":"Almoutairi","sequence":"additional","affiliation":[{"name":"Regional Laboratory, Ministry of Health, Madinah P.O. Box 935, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renad M.","family":"Alhamawi","sequence":"additional","affiliation":[{"name":"Clinical Laboratory Sciences Department, College of Applied Medical Sciences, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6977-9006","authenticated-orcid":false,"given":"Waleed H.","family":"Mahallawi","sequence":"additional","affiliation":[{"name":"Clinical Laboratory Sciences Department, College of Applied Medical Sciences, Taibah University, Madinah 42353, Saudi Arabia"},{"name":"Health and Life Research Center, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/j.1538-7836.2006.01753.x","article-title":"International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)","volume":"4","author":"Miyakis","year":"2006","journal-title":"J. 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