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Circulating aggregated platelets, number of platelets per aggregate and platelet size in chronic dialysis patients
J Winkler1, J Fuchs, G Morduchowicz
1Institute of Hypertension and Kidney Diseases, Rabin Medical Center, Petah Tikva, Israel.
Insights
Chronic dialysis patients exhibit significant platelet function abnormalities, contributing to their high rates of cardiovascular disease (CVD). These platelet changes, distinct from platelet count, indicate increased risk for atherosclerosis and related complications.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Hematology
Background:
- Accelerated arteriosclerosis is a common, multifactorial complication in chronic dialysis patients.
- Both non-uremic and uremic patients with atherosclerosis display functional platelet abnormalities.
- Understanding platelet function is crucial for addressing cardiovascular morbidity in dialysis populations.
Purpose of the Study:
- To investigate platelet function in patients undergoing chronic dialysis.
- To correlate observed platelet function parameters with the presence of cardiovascular morbidity.
- To elucidate the role of platelet abnormalities in the etiology of cardiovascular disease (CVD) in dialysis patients.
Main Methods:
- Study included 53 chronic dialysis patients, assessing cardiovascular disease (CVD) risk factors and clinical manifestations.
- Platelet function was evaluated using the modified Wu and Hoak method.
- Key parameters measured: platelet count, aggregation (total, reversible, irreversible), platelets per aggregate, and large platelet percentage.
Main Results:
- Dialysis patients showed significant differences in totally, reversibly, and irreversibly aggregated platelets compared to controls (p < 0.0001).
- The percentage of large platelets (p < 0.0001) and average platelets per aggregate (p < 0.001) were significantly higher in dialysis patients.
- No significant differences in platelet count or effects of dialysis modality (hemodialysis vs. peritoneal dialysis) or duration were observed.
Conclusions:
- Chronic dialysis patients exhibit distinct platelet function abnormalities, including altered aggregation patterns and increased large platelets.
- These platelet abnormalities are integral to the multifactorial etiology of advanced cardiovascular disease (CVD) in this population.
- The identified platelet dysfunctions may predispose chronic dialysis patients to cardiovascular complications.
Abstract:
The accelerated arteriosclerosis of chronic dialysis patients is multifactorial. Both non-uremic patients with atherosclerosis and uremic patients have functional platelet abnormalities. Our aim was to study platelet function in chronic dialysis patients and to correlate the findings with the presence of cardiovascular morbidity. Fifty-three chronic dialysis patients were examined. The presence of risk factors for cardiovascular disease (CVD) was recorded, and the patients were examined for the presence of ischemic heart disease, peripheral vascular disease and cerebrovascular accident. The parameters of platelet function, which were examined with the modified Wu and Hoak method, included platelet number, percentage of totally, reversibly and irreversibly aggregated platelets, average number of platelets per aggregate and percentage of large platelets. Significant differences were found between totally aggregated platelets, reversibly and irreversibly aggregated platelets, the percentage of large platelets (p < 0.0001) and the average number of platelets per aggregate (p < 0.001) in dialysis patients compared with control persons. There was no difference between the 2 groups in platelet count. No differences were found between hemodialysis and peritoneal dialysis groups, and the duration of dialysis treatment had no effect. We conclude that platelet abnormalities evident in chronic dialysis patients are a part of the multifactorial etiology of advanced CVD and may predispose dialysis patients to CVD.