Key result
Hemodialysis did not significantly alter platelet thrombogenicity in patients with end-stage renal disease, with median AUC10 of 10.25 before and 20.3 after the procedure (p=0.37).
Why the study?
Patients with end-stage renal disease receiving hemodialysis often experience bleeding, but the mechanisms behind this tendency are incompletely understood and may involve platelet dysfunction.
Does hemodialysis influence platelet-dependent thrombus formation in patients with end-stage renal disease?
Observational (n=22)
No
Does hemodialysis influence platelet-dependent thrombus formation in patients with end-stage renal disease?
Absolute Event Rate: 20.3% vs 10.25%
p-value: p=0.37
Most ESRD patients display moderate-to-severe platelet dysfunction that is not influenced by hemodialysis despite HD-induced elevations in VWF.
Most HD patients exhibit persistent platelet dysfunction independent of VWF; leaves open T-TAS01 role in bleeding risk assessment.
BACKGROUND: Patients with end-stage renal disease (ESRD) receiving hemodialysis (HD) often experience bleeding. However, mechanisms behind this bleeding tendency are incompletely understood but may involve platelet dysfunction. We, therefore, studied platelet-dependent thrombus formation in flowing whole blood inside a microchip coated with collagen, and its association with circulating von Willebrand factor (VWF). METHODS: Blood samples were obtained in 22 patients before and after HD. The area under the 10 min flow pressure curve in a microchip (AUC10) reflecting total platelet thrombogenicity was measured, using the Total Thrombus-formation Analysis System (T-TAS01). AUC10 < 260 indicates platelet dysfunction. VWF activity and antigen in plasma were also assayed. RESULTS: VWF levels were moderately elevated and increased further after HD (P < 0.01 or lower). In contrast, AUC10 before and after HD was < 260 in 17/22 patients and < 130 in 15/22 patients, with no statistically significant difference in pre- vs post-HD measurements, indicating reduced platelet thrombogenicity, but with some variability as 5/22 patients showed normal platelet responsiveness. AUC10 and VWF activity or antigen levels in plasma were not correlated, either before or after HD. CONCLUSIONS: Most ESRD patients display moderate-to-severe platelet dysfunction as assessed by shear-induced platelet-dependent thrombus formation with T-TAS01. HD does not influence platelet function despite HD-induced elevations in VWF. T-TAS01 should be further evaluated as a tool in the assessment of bleeding risk in patients on HD.
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Mitić et al. (2022) conducted an observational in End-stage renal disease (n=22). Hemodialysis vs. Before hemodialysis was evaluated on Platelet thrombogenicity expressed as AUC10 (area under the flow pressure curve for 10 min) (p=0.37). Hemodialysis did not significantly alter platelet thrombogenicity in patients with end-stage renal disease, with median AUC10 of 10.25 before and 20.3 after the procedure (p=0.37).
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