Platelet-Based Markers Associated With Vascular Access Dysfunction in Hemodialysis Patients

Area of Science:

• Nephrology
• Hematology
• Clinical Diagnostics

Background:

• Vascular access (VA) dysfunction is a critical issue in hemodialysis (HD), impacting treatment delivery and patient outcomes.
• Mean platelet volume (MPV), a marker of platelet activation, is being investigated for its role in thrombotic events and VA complications.

Purpose of the Study:

• To assess the association and discriminatory performance of platelet indices, especially MPV, in detecting VA dysfunction in chronic HD patients.
• To explore the relationship between platelet parameters, dialysis adequacy, and hematologic markers.

Main Methods:

• A retrospective analysis of 104 HD patients (2017-2021) comparing arteriovenous fistula (AVF) and permanent catheter (PC) groups.
• Evaluation of MPV and platelet count (PLT) against VA dysfunction, dialysis adequacy (spKt/V, URR%), and anemia parameters (Hgb, ESAs).
• Utilized correlation, comparative analyses, and receiver operating characteristic (ROC) curve analysis.

Main Results:

• MPV was significantly higher in PC patients compared to AVF patients (p<0.00001).
• Elevated MPV correlated with reduced dialysis flow (Qb), lower dialysis adequacy (spKt/V), higher erythropoiesis-stimulating agent (ESA) requirements, and lower hemoglobin (Hgb) levels (p<0.001).
• ROC analysis demonstrated excellent discriminatory performance for MPV in identifying VA dysfunction (AUC ≈ 0.96) in both AVF and PC groups, with specific optimal cut-off values.

Conclusions:

• MPV is strongly associated with VA dysfunction in HD patients, reflecting impaired dialysis performance.
• Higher MPV values indicate increased risk of VA complications, reduced dialysis adequacy, and poorer anemia control.
• MPV serves as a readily available biomarker with potential clinical relevance for monitoring VA status in HD patients.