Key result
Chronic kidney disease patients on hemodialysis exhibited significantly higher P2Y12 reaction units compared to patients with normal renal function (299.2 vs 241.7, p<0.001), independent of hemoglobin levels.
Why the study?
PRU has an inverse relation with hemoglobin level, and CKD is associated with low response to clopidogrel and low hemoglobin, but whether hemoglobin directly affects PRU in hemodialysis patients was unclear.
Does chronic hemodialysis increase platelet reactivity independently of hemoglobin levels in patients with stable coronary artery disease on dual antiplatelet therapy?
Observational (n=170)
No
Does chronic hemodialysis increase platelet reactivity independently of hemoglobin levels in patients with stable coronary artery disease on dual antiplatelet therapy?
Absolute Event Rate: 299.2% vs 241.7%
p-value: p=<.001
Higher P2Y12 reactivity on DAPT in hemodialysis should not change practice; leaves open need for outcome trials in stable CAD.
BACKGROUND: VerifyNow (VN; Accumetrics, San Diego, CA) P2Y12 reaction unit (PRU) has an inverse relation with hemoglobin level (Hb). Chronic kidney disease (CKD) is associated with low response to clopidogrel and low Hb. Our aim is to investigate the relation between PRU and Hb, and to assess whether Hb directly affects PRU or not in patients with CKD undergoing hemodialysis (HD). METHODS: We analyzed the relation between PRU and Hb in 43 HD patients and compared it with a control group of 127 patients with normal renal function. Both groups underwent percutaneous coronary intervention for stable coronary artery disease. We also compared PRU between the 2 groups considering Hb as a confounding factor. RESULTS: In the control group, Hb and PRU showed a significant inverse correlation (correlation coefficient r = -0.340; P < .001), but not in the HD group (correlation coefficient r = -0.099; P = .53). PRU was higher in the HD group than the control group after adjusting for the influence of Hb (299.2 [95% confidence interval: 278.4-316.7] vs 248.7 [95% confidence interval: 227.7-269.0]; P < .001), even after propensity score matching (299.2 [95% confidence interval: 278.4-316.7] vs 241.7 [95% confidence interval: 221.8-262.2]; P < .001). CONCLUSIONS: PRU was higher regardless of lower Hb in CKD on HD patients than normal renal function patients. Therefore, Hb was not crucial factor to decide PRU in CKD on HD patients in this study.
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Kim et al. (2020) conducted an observational in Stable coronary artery disease (n=170). Chronic kidney disease on hemodialysis vs. Normal renal function was evaluated on P2Y12 reaction unit (PRU) after propensity score matching (p=<.001). Chronic kidney disease patients on hemodialysis exhibited significantly higher P2Y12 reaction units compared to patients with normal renal function (299.2 vs 241.7, p<0.001), independent of hemoglobin levels.
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