Abstract
Purpose The predominant cause of mortality in dialysis patients are cardiovascular events. Platelet and monocyte activity markers play an important role in cardiovascular mortality and were assessed and related to dialysis quality criteria in haemodialysis (HD) and peritoneal dialysis (PD) patients. Methods For this prospective comparative study, HD patients (n = 41) and PD patients (n = 10) were included. In whole blood samples, surface expression of CD62P and CD40L on platelets, tissue factor binding on monocytes, and platelet-monocyte aggregates were measured by flow cytometry. Plasma levels of MCP-1, IL-6, TNFα, and soluble CD40L were analysed by enzyme-linked immunosorbent assay. Results Haemodialysis patients showed a significantly higher CD62P expression on platelets (p = 0.017), significantly higher amount of platelet-monocyte aggregates (p < 0.0001), and significantly more tissue factor binding on monocytes (p < 0.0001) compared to PD patients. In PD patients, a significant correlation between Kt/V and platelet CD40L expression (r = 0.867; 0.001) and between Kt/V and platelet CD62P expression (r = 0.686; p = 0.028) was observed, while there was no significant correlation between Kt/V and tissue factor binding on monocytes and platelet-monocyte aggregates, respectively. Conclusion Platelet and monocyte activity markers are higher in HD patients in comparison with those in PD patients, possibly suggesting a higher risk of cardiovascular morbidity and mortality.
Highlights
End-stage renal disease is associated with increased cardiovascular mortality and morbidity
We found a significantly higher amount of platelet-monocyte aggregates (19.3 ± 10.4 versus 6.6 ± 4.2; p < 0 0001) (Figure 2) and tissue factor binding on monocytes (1.3 ± 0.3 versus 0.9 ± 0.2; p < 0 0001) in HD patients compared to that in peritoneal dialysis (PD) patients (Figure 3)
In PD patients, we found a significant correlation between Kt/V and CD40 receptor and its ligand (CD40L) (r = 0 867; 0.001) and between Kt/V and CD62P (r = 0 686; p = 0 028), while there was no significant correlation between Kt/V and tissue factor binding on monocytes and platelet-monocyte aggregates, respectively
Summary
End-stage renal disease is associated with increased cardiovascular mortality and morbidity. The mortality rate in patients with end-stage renal disease (ESRD) is comparable to many cancers and is mostly caused by an increased mortality rate due to cardiovascular disease. Possible correlations between dialysis dose and mortality have been studied in major trials with disappointingly negative results for both haemodialysis and peritoneal dialysis patients [1, 2]. Alterations in haemostasis are common complications of kidney diseases. Their frequency and severity correlate with the progressive loss of renal function to end-stage renal disease.
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