Platelet Abnormalities in CKD and Their Implications for Antiplatelet Therapy

Area of Science:

• Nephrology
• Hematology
• Cardiology

Background:

• Patients with chronic kidney disease (CKD) have a high risk of cardiovascular and thromboembolic events, often dying from cardiovascular disease.
• Paradoxically, CKD patients also exhibit an increased risk of hemorrhages, complicating therapeutic interventions.
• Platelets play a critical role in hemostasis, and their altered function (hyper- or hyporeactivity) in CKD may underlie these thrombotic and hemorrhagic complications.

Purpose of the Study:

• To review and summarize current knowledge on CKD-induced hemostasis aberrations, focusing on platelet abnormalities.
• To discuss the contribution of altered vascular integrity, coagulation, and red blood cell count to hemostasis dysfunction in CKD.
• To analyze antiplatelet treatment strategies, their risks and benefits (thrombosis vs. bleeding), and clinical outcomes in CKD patients.

Main Methods:

• Literature review and synthesis of existing research on hemostasis and platelet function in CKD.
• Analysis of molecular changes affecting platelet activity in CKD.
• Evaluation of clinical data regarding antiplatelet therapy efficacy and safety in different CKD stages.

Main Results:

• CKD is associated with significant molecular changes leading to altered platelet function, impacting hemostasis.
• Vascular integrity, coagulation pathways, and red blood cell parameters are also affected in CKD, contributing to hemostatic dysregulation.
• Antiplatelet therapy in CKD requires careful risk-benefit assessment due to the dual risk of thrombosis and bleeding, with outcomes varying by CKD stage.

Conclusions:

• Altered platelet activity and hemostasis are key features of CKD, contributing to high cardiovascular and bleeding risks.
• Optimizing antiplatelet therapy in CKD necessitates a deeper understanding of underlying platelet mechanisms.
• Further research into platelet function and tailored antiplatelet strategies is essential for improving clinical outcomes in high-risk CKD patients.