Abstract
After stenosis of arteriovenous vascular access in hemodialysis patients, platelets play a crucial role in subsequent thrombus formation, leading to access failure. In a previous study, the mean platelet volume (MPV)/platelet count ratio, but not MPV alone, was shown to be an independent predictor of 4-year mortality after myocardial infarction. However, little is known about the potential influence of MPV/platelet count ratio on vascular access patency in hemodialysis patients. A total of 143 patients undergoing routine hemodialysis were recruited between January 2013 and February 2016. Vascular access failure (VAF) was defined as thrombosis or a decrease of greater than 50% of normal vessel diameter, requiring either surgical revision or percutaneous transluminal angioplasty. Cox proportional hazards model analysis ascertained that the change of MPV/platelet count ratio between baseline and 3 months [Δ(MPV/platelet count ratio)3mo-baseline] had prognostic value for VAF. Additionally, the changes of MPV/platelet count ratio over time were compared in patients with and without VAF by using linear mixed model analysis. Of the 143 patients, 38 (26.6%) were diagnosed with VAF. During a median follow-up of 26.9 months (interquartile range 13.0–36.0 months), Δ(MPV/platelet count ratio)3mo-baseline significantly increased in patients with VAF compared to that in patients without VAF [11.6 (6.3–19.0) vs. 0.8 (-1.8–4.0), P< 0.001]. In multivariate analysis, Δ(MPV/platelet ratio count)3mo-baseline was an independent predictor of VAF, after adjusting for age, sex, diabetes, hypertension, coronary artery disease, cerebrovascular disease, vascular access type, the presence of previous VAF, and antiplatelet drug use (hazard ratio, 1.15; 95% confidence interval, 1.10–1.21; P< 0.001). Moreover, a liner mixed model revealed that there was a significant increase of MPV/platelet count ratio over time in patients with VAF compared to those without VAF (P< 0.001). An increase in MPV/platelet count ratio over time was an independent risk factor for VAF. Therefore, continuous monitoring of the MPV/platelet count ratio may be useful to screen the risk of VAF in patients undergoing routine hemodialysis.
Highlights
Vascular access failure (VAF) substantially contributes to morbidity and hospitalization in hemodialysis patients [1, 2]
The systolic and diastolic blood pressure, serum Hb levels, platelet counts, mean platelet volume (MPV) levels, cholesterol levels, albumin levels, calcium levels, phosphate levels, parathyroid hormone (PTH) levels, and Kt/V were comparable between the 2 groups
Δ(MPV/ platelet count ratio)3mo-baseline remained a significant independent risk factor for VAF, even after adjusting for age, sex, diabetes, coronary artery disease, cerebrovascular disease, and vascular access type
Summary
Vascular access failure (VAF) substantially contributes to morbidity and hospitalization in hemodialysis patients [1, 2]. Thrombosis is a leading cause of VAF and usually results from stenotic lesions in the venous outflow system [3, 4]. These lesions develop from progressive neointimal hyperplasia, whose pathogenesis is similar to that of a classic atheroma [5, 6]. The mean platelet volume (MPV) is calculations performed by automated blood analyzers using either electrical impedance or optical fluorescence method. It reflects the average size of platelets in a blood sample [16, 17]. Various studies have demonstrated that elevated MPV was associated with a higher rate of restenosis after coronary angioplasty and a higher rate of major adverse cardiovascular events in patients with non-ST elevation acute coronary syndrome [18, 19]
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