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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Impact of renal function on mean platelet volume and its relationship with coronary artery disease: A single-centre
Monica Verdoia1, Lucia Barbieri1, Alon Schaffer1
1Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara. Italy.
Insights
Patients with chronic kidney disease (CKD) have higher mean platelet volume (MPV), a marker of platelet reactivity. However, increased platelet size in CKD does not explain the greater severity of coronary artery disease observed in these individuals.
Area of Science:
- Cardiology
- Nephrology
- Hematology
Background:
- Mean platelet volume (MPV) is a potential marker for platelet reactivity and cardiovascular disease.
- Chronic kidney disease (CKD) is associated with increased cardiovascular events due to pro-oxidant and pro-thrombotic mediators.
- Platelet function in CKD patients shows conflicting reports regarding aggregability and bleeding, impacting MPV and coronary artery disease (CAD) outcomes.
Purpose of the Study:
- To investigate the relationship between renal function, MPV, and the severity of coronary artery disease (CAD) in patients undergoing coronary angiography.
- To determine if MPV is an independent predictor of CAD severity in the context of CKD.
Main Methods:
- Assessed MPV, serum creatinine, and estimated glomerular filtration rate (eGFR) in 3712 patients at admission for coronary angiography.
- Defined coronary artery disease (CAD) as >50% stenosis in at least one coronary vessel; severe CAD included left main or trivessel disease.
- Utilized multivariate analysis to identify independent predictors of MPV and CAD severity.
Main Results:
- 28.1% of patients had CKD, which was associated with older age, female gender, diabetes, and other comorbidities.
- CKD patients exhibited increased CAD severity and complexity (p<0.001) and significantly larger MPV (p<0.001).
- Higher MPV (≥10.85fl) in CKD patients was linked to age and hematological parameters but not to increased CAD prevalence or severity.
Conclusions:
- Elevated MPV values are prevalent in CKD patients and inversely correlate with eGFR.
- Increased platelet size (MPV) in CKD patients does not appear to be a contributing factor to the heightened severity of coronary artery disease observed in this population.
Background:
Mean platelet volume (MPV) has been proposed as a marker of platelet reactivity and cardiovascular disease. Chronic kidney disease (CKD) significantly favors the occurrence of cardiovascular events, by increasing the circulating levels of a wide spectrum of pro-oxidant and pro-thrombotic mediators. However, opposite alterations of platelet function, both enhanced aggregability and increased bleeding diathesis have been reported in these patients, with contrasting results on the effects of renal function on MPV and coronary artery disease, that were assessed in present study.
Methods:
In patients undergoing coronary angiography, MPV and renal function (serum creatinine and estimated Glomerular Filtration Rate, eGFR, by MDRD formula) were assessed at admission. Coronary artery disease (CAD) was defined as a stenosis >50% in at least 1 coronary vessel, while severe CAD as left main or trivessel disease.
Results:
Among 3712 patients, 1044 (28.1%) had chronic kidney disease. CKD was related with age, female gender, diabetes and glycemic control, history of myocardial infarction, cerebrovascular accidents, coronary artery bypass grafting and left ventricular dysfunction or arrhythmias as indication to angiography, therapy with angiotensin-receptor blockers, nitrates, diuretics and calcium-antagonists, but lower rate of smoking, lower fibrinogen levels, haemoglobin, total and HDL cholesterol (p<0.001, respectively). CKD patients displayed increased severity and complexity of CAD (p<0.001) and significantly larger platelet volume (p<0.001), with CKD resulting as independent predictor of MPV above the median (≥10.85fl; Adjusted OR[95%CI]=1.56[1.23,1.99], p=0.002). Moreover, in the 1044 patients with renal failure, higher platelet volume (above the median value; ≥10.85fl) was associated with age (p=0.05), haemoglobin levels and platelet count (p<0.001), but not to a higher prevalence or extent of coronary artery disease (CAD: adjusted OR[95%CI]=0.80[0.58-1.09], p=0.16; severe CAD, adjusted OR[95%CI]=1.07[0.81-1.41], p=0.65).
Conclusions:
Higher values of MPV are observed among patients with chronic kidney disease, inversely relating to eGFR. However, larger platelet size does not contribute to explain the increased severity of coronary artery disease observed among these patients.
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