|Year : 2021 | Volume
| Issue : 1 | Page : 129-134
Effect of the mean platelet volume/platelet count ratio on arteriovenous fistula function in chronic hemodialysis patients
Hassan A Ahmed1, Mahmoud M Emara1, Heba E Kasem1, Manar A. H. Tahoon2
1 Department of Internal Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Resident of Internal Medicine at Ministry of Health, Shebein El Koum Teaching Hospital, Menoufia, Egypt
|Date of Submission||04-Aug-2019|
|Date of Decision||17-Sep-2019|
|Date of Acceptance||29-Sep-2019|
|Date of Web Publication||27-Mar-2021|
Manar A. H. Tahoon
Shebin Elkom, Menoufia
Source of Support: None, Conflict of Interest: None
The aim was to study the effect of increased mean platelet volume/platelet count (MPV/PL count) on arteriovenous fistula (AVF) function in chronic hemodialysis (HD) patients.
Vascular access failure substantially contributes to morbidity and hospitalization in HD patients.
Patients and methods
A case–control study was conducted on 50 HD patients on regular HD for more than 6 months in Shebin El-Koom Teaching Hospital, Menoufia, Egypt. The patients were divided into two groups: 25 patients with functioning AVF as group 1 and 25 patients with nonfunctioning AVF as group 2. Patients were subjected to full history taking, clinical examination, laboratory workup, and radiology by Duplex ultrasound.
There was no significant effect of age, sex, BMI, diabetes mellitus, hypertension, smoking, or type of anastomosis on AVF in HD patients. There was a significant effect of intradialysis hypotension on AVF in HD patients. There was a highly significant effect of fistula function on Kt/V in HD patients. There was a highly significant increase of MPV/PL count ratio in HD patients with failure of AVF. MPV/PL count at a cut-off level of 53.7 can accurately predict failure of AVF in the studied HD patients with 100% sensitivity and 84% specificity.
Assessment of MPV/PC ratio could adequately predict the failure of the function of AVF in the studied patients.
Keywords: arteriovenous fistula, hemodialysis, intradialysis hypotension, mean platelet volume/platelet count ratio, vascular access failure
|How to cite this article:|
Ahmed HA, Emara MM, Kasem HE, Tahoon MA. Effect of the mean platelet volume/platelet count ratio on arteriovenous fistula function in chronic hemodialysis patients. Menoufia Med J 2021;34:129-34
|How to cite this URL:|
Ahmed HA, Emara MM, Kasem HE, Tahoon MA. Effect of the mean platelet volume/platelet count ratio on arteriovenous fistula function in chronic hemodialysis patients. Menoufia Med J [serial online] 2021 [cited 2021 May 8];34:129-34. Available from: http://www.mmj.eg.net/text.asp?2021/34/1/129/312021
| Introduction|| |
Vascular access failure (VAF) substantially contributes to morbidity and hospitalization in hemodialysis (HD) patients. Thrombosis is a leading cause of VAF and usually results from stenotic lesions in the venous outflow system . Although the occurrence of VAF and atherosclerotic lesions may share some similar pathogenic mechanisms, there have been few effective treatments to prevent VAF because of poor understanding of its pathogenesis. Therefore, the initial step in managing HD patients is to identify patients with high risk for VAF and the next step is to require aggressive prevention and intervention strategies . Platelets play a central role in the formation of a classic atheroma, leading to peripheral arterial disease, coronary artery disease, and ischemic stroke . The mean platelet volume (MPV) is a calculation performed by automated blood analyzers using either electrical impedance or optical fluorescence method. It reflects the average size of platelets in a blood sample. Therefore, considerable attention has been paid to MPV as a possible marker of platelet function and activation . 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. In addition to the predictive value of the MPV, platelet (PL) counts might also predict outcomes after myocardial infarction. Furthermore, in a study evaluating MPV and PL count data, it was found that patients with the acute coronary syndrome had lower counts and larger platelet volumes in comparison with those with stable angina. Moreover, there was an inverse relationship between MPV and PL counts in a normal population ,. Therefore, this study was aimed to study the effect of increased MPV/PL count on A-V fistula function in chronic HD patients.
| Patients and methods|| |
This study was approved by the Institutional Review Board (IRB) of the Menoufia Faculty of Medicine. Written consent was taken from the participants.
A case–control study was conducted in Shebin El-Koom Teaching Hospital, Menoufia, Egypt.
This study was conducted on 50 HD patients on regular HD from August 2018 to February 2019 who fulfilled inclusion criteria. Inclusion criteria included patient age more than 18 years old, patients on HD more than 6 months, and patients dependent on A-V fistula as permanent vascular access. Exclusion criteria included patients who had a medical condition that may cause thrombophilia (antiphospholipid syndrome, polycythemia, etc.), history of congestive heart failure, and previous vascular access surgical intervention. Patients were divided into two groups: group 1 included 25 patients with functioning A-V fistula and group 2 included 25 patients with nonfunctioning A-V fistula.
Patients were subjected to the following: full history taking, complete clinical examination including measurement of arterial blood pressure (intradialytic hypotension is defined as symptomatic sudden drop systolic blood pressure ≥30 mmHg during dialysis or a decrease in the mean blood pressure by ≥10 mmHg) , weight, height, and BMI. In addition, laboratory parameters such as MPV level, PL count, white blood cell count, and hemoglobin (Hb) level were analyzed from blood samples using an autoanalyzer (ADVIA 2120 Hematology System, Siemens Healthcare Diagnostics, Forchheim, Germany). Routine chemistry was assessed by an autoanalyzer (Beckman Coulter AU5800; Beckman Coulter Inc., Brea, California, USA). The time between the drawing of blood samples and the analysis of the specimens was less than 30 min. Kt/V was determined according to the procedure of Gotch . URR (urea reduction ratio) was calculated using the formula: 1−(post-BUN/pre-BUN) . Duplex ultrasound was done on the A-V fistula to assess flow rate (FR) and resistive index (RI).
Data were collected and entered into the computer using SPSS (Statistical Package for the Social Sciences program version 20; SPSS Inc., Chicago, Illinois, USA) for statistical analysis. χ2-Test was used to measure association between qualitative variables. Fisher exact test was used for 2 × 2 qualitative variables when more than 25% of the cells have expected count less than 5. Student's t-test was used to compare mean and SD of two sets of quantitative normally distributed data, whereas Mann–Whitney test (U) was used when the data were not normally distributed. The receiver operating characteristic curve was done to detect the cutoff value with highest sensitivity and specificity. Sensitivity, specificity, positivepredictive value, negative predictive value, and diagnostic accuracy were calculated.
P value was considered statistically significant when it is less than 0.05.
| Results|| |
There was no statistically significant difference between functioning and failure groups regarding their age, sex, and BMI (P = 0,755, 0.777, and 0.475, respectively) [Table 1]. There was a statistically significant difference between functioning and failure groups regarding intradialysis hypotension, as 76% of the failure group had intradialysis hypotension compared with 48% of the functioning group (P = 0.041); however, there was no statistically significant difference between functioning and failure groups regarding history of diabetes mellitus, hypertension, smoking, and duration of HD (P = 0.747, 0.355, 0.733, and 0.961, respectively). There was a statistically significant difference between the study groups regarding PL count, showing higher PL count in group 2 (166.5) than group 1 (115.4). There was also a statistically significance difference between study groups regarding CRP, as group 2 had higher CRP than group 1. However, there was no statistical significance difference between group 1 and group 2 regarding Hb and PL volume. There was a statistically significant difference between the study groups regarding KT/V and URR, as group 1 (1.18 and 71.1, respectively) had higher KT/V and URR than group 2 (0.79 and 51.5, respectively). There was a statistically significant difference between functioning and failure regarding their MPV/count ratio, as group 2 had higher MPV/PL count ratio (60.3) than functioning group (46.2). There was a statistically significance difference between the study groups regarding serum low-density lipoprotein, as group 1 (functioning) had higher low-density lipoprotein (163 mg/dl) than group 2 (failure) (92.7 mg/dl). Moreover, there was a statistically significant difference between the study groups regarding serum high-density lipoprotein, showing lower high-density lipoprotein levels in group 1 (40.2) than group 2 (47.5). However, there was no statistically significant difference between the study groups regarding serum cholesterol, serum triglyceride, and fasting blood sugar [Table 2]. There was a statistically significant difference between the study groups regarding the history of functioning fistula with complications, as 68% of group 2 had functioning fistula with a complication compared with 8% of the group 1. There was a statistically significant difference between the study groups regarding arm elevation test, as 100% of the group 1 had positive arm elevation test in comparison with 8% of the group 2. There was a statistically significant difference between study groups regarding history of ischemia, as 20% of group 2 had a history of ischemia compared with 0% of group 1. There was a statistically significant difference between the study groups regarding the presence of edema, showing 52% of group 2 had edema compared with 8% of group 1. There was a statistically significant difference between the study groups regarding the recirculation test, as group 2 had a higher recirculation test (23.9) than group 1 (9.16) [Table 3]. On the contrary, there was no statistically significant difference between the functioning and failure groups regarding arteriovenous fistula (AVF), age, history of thrombosis, and aneurysm. There were statistically significant differences between the study groups regarding velocity, flow rate, and resistance index; however, there was no statistically significant difference between the study groups regarding arterial diameter and venous diameter [Table 4]. The best cutoff point of MPV/PL count ratio for predicting failure of the A-V fistula function in the studied chronic HD patients was 53.7, with sensitivity of 100%, specificity of 84%, PPV of 86%, NPV of 100%, and overall accuracy of 92% [Figure 1].
|Table 3: Clinical assessment of the arteriovenous fistula in the studied groups|
Click here to view
|Figure 1: Receiver operating characteristic curve of mean platelet volume/platelet count ratio for predicating failure of the A-V fistula function in chronic hemodialysis patients.|
Click here to view
| Discussion|| |
Vascular access dysfunction is a major cause of morbidity and mortality in HD patients and accounts for 20–30% of annual hospital admissions . Little is known about the potential influence of MPV/PL count ratio on vascular access patency in HD patients ,. Therefore, we have studied the effect of increased MPV/PL count on A-V fistula function in chronic HD patients. This study showed that an increase in MPV/PL count ratio was significantly associated with VAF. This comes in line with other studies ,,,,,,,,,,,. In our study, there was no statistical significant effect of age, sex, BMI, history of diabetes mellitus, hypertension, and smoking on VAF (P > 0.05). Contrary to this, several studies have demonstrated that older age, diabetes, male sex, obesity cardiovascular disease, and smoking were associated with VAF in HD patients ,,,. This could be justified by small sample size. In our study, there was a significant difference between the two groups regarding intradialysis hypotension. The same was observed by other investigators ,. Furthermore, several studies have recently suggested that dyslipidemia is a well-known risk factor of vascular disease in HD patients ,. However, in our study, serum cholesterol level was not associated with VAF. Metabolic bone markers are important risk factors for vascular calcification, thus may affect A-V fistula function ,. Contrary to this, there was no significant difference between the two groups regarding serum calcium and serum phosphorus. However, there was a significant difference between the two groups regarding ca x po4 product. This comes in line with another study . In our results, there was a highly significant difference between the two groups. This result is in agreement with Chung et al. . We found that there was no significant difference between the two groups based on the Hb level. This result is in agreement with Moon et al.  who found no significant effect of Hb level on A-V function in HD patients. In our study, there was a highly significant difference between the two groups regarding KT/V and URR. The same was observed by other studies ,. By Doppler on AVF, there was a highly significant difference between the two groups regarding the flow rate, velocity, and resistive index, which were higher in group I. This result is in agreement with Çildağ and Köseoğlu , who found a significant difference between Doppler parameters (flow rate, velocity, and resistive index) based on A-V function in HD patients, as they found that these parameters were high in patients with functioning AVF.
| Conclusion|| |
This study showed that an increase in MPV/PL count ratio was associated with VAF in HD patients. Although further studies are needed to elucidate the role of the MPV/PL count ratio as a risk factor for VAF, the result suggests that continuous monitoring of the ratio may be useful to screen the risk for VAF in patients undergoing routine HD. In addition, a prospective trial testing the utility of anti PL agents is needed in the setting of high corrected MPV.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shin DH, Rhee SY, Jeon HJ, Park JY, Kang SW, Oh J. an increase in mean platelet volume/platelet count ratio is associated with vascular access failure in hemodialysis patients. PLoS One. 2017; 12
Roy-Chaudhury P, Sukhatme VP, Cheung AK. Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint. J Am Soc Nephrol 2006; 17
Boos CJ, Lip GY. Platelet activation and cardiovascular outcomes in acute coronary syndromes. J Thromb Haemost 2006; 4
Briggs C. Quality counts: new parameters in blood cell counting. Int J Lab Hematol 2009; 31
Park KM, Moon IS, Kim JI. Mechanical thrombectomy with Trerotola compared with catheter-directed thrombolysis for treatment of acute iliofemoral deep vein thrombosis. Ann Vasc Surg 2014; 28
Azab B, Torbey E, Singh J, Akerman M, Khoueiry G, McGinn JT, et al.
Mean platelet volume/platelet count ratio as a predictor of long-term mortality after non-ST-elevation myocardial infarction. Platelets 2011; 22
Hirakata H, Nitta K, Inaba M, Shoji T, Fujii H, Kobayashi S, et al
. Japanese Society for Dialysis Therapy. Japanese Society for Dialysis Therapy guidelines for management of cardiovascular diseases in patients on chronic hemodialysis. Ther Apher Dial. 2012; 16
:387-435. doi: 10.1111/j.1744-9987.2012.01088.x. PMID: 23046367.
Liang KV, Zhang JH, Palevsky PM. Urea reduction ratio may be a simpler approach for measurement of adequacy of intermittent hemodialysis in acute kidney injury. BMC Nephrol 2019; 20
:82. doi: 10.1186/s12882-019-1272-7. PMID: 30841863; PMCID: PMC6404330.
Sherman RA, Cody RP, Rogers ME, Solanchick JC. Accuracy of the urea reduction ratio in predicting dialysis delivery. Kidney Int. 1995; 47
:319-21. doi: 10.1038/ki.1995.41. PMID: 7731164.
Hammes M. Hemodynamic and biologic determinates of arteriovenous fistula outcomes in renal failure patients. Biomed Res Int 2015; 2015
Momeni A, Mardani S, Kabiri M, Amiri M. Comparison of complications of arteriovenous fistula with permanent catheter in hemodialysis patients: a six-month follow-up. Adv Biomed Res 2017; 6
Jeon HJ, Rhee SY, Oh J, Shin DH. SP532 an increase in mean platelet volume/platelet count ratio is associated with vascular access failure in hemodialysis patients. Nephrol Dialysis Transplant 2016; 31 (Suppl 1)
Smith GE, Gohil R, Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access. J Vasc Surg 2012; 55
Feldman HI, Joffe M, Rosas SE, Burns JE, Knauss J, Brayman K. Predictors of successful arteriovenous fistula maturation. Am J Kidney Dis 2003; 42
Alvitigala BY, Azra MA, Kottahachchi DU, Jayasekera MM, Wijesinghe RA. A study of association between platelet volume indices and ST elevation myocardial infarction. Int J Cardiol Heart Vasc 2018; 21
Beaulieu MC, Dumaine CS, Romann A, Kiaii M. Advanced age is not a barrier to creating a functional arteriovenous fistula: a retrospective study. J Vasc Access 2017; 18
Masengu A, Maxwell AP, Hanko JB. Investigating clinical predictors of arteriovenous fistula functional patency in a European cohort. Clin Kidney J 2015; 9
Deighan CJ, Caslake MJ, McConnell M, Boulton-Jones JM, Packard CJ. Atherogenic lipoprotein phenotype in end-stage renal failure: origin and extent of small dense low-density lipoprotein formation. Am J Kidney Dis 2000; 35
Bashar K, Conlon PJ, Kheirelseid EA, Aherne T, Walsh SR, Leahy A. Arteriovenous fistula in dialysis patients: Factors implicated in early and late AVF maturation failure. Surgeon 2016;14:294-300. doi: 10.1016/j.surge.2016.02.001. Epub 2016 Mar 15. PMID: 26988630.
Bashar K, Conlon PJ, Kheirelseid EA et al.
Arteriovenous fistula in dialysis patients: factors implicated in early and late AVF maturation failure. Surgeon 2016; 14
Siddiqui MA, Ashraff S, Santos D, Rush R, Carline T, Raza Z. Predictive parameters of arteriovenous fistula maturation in patients with end-stage renal disease. Kidney Res Clin Pract 2018; 37
Chung S, Jeong HS, Choi DE, Song HJ, Lim YG, Ham JY, et al
. The Impact of Hemodialysis and Arteriovenous Access Flow on Extracranial Hemodynamic Changes in End-Stage Renal Disease Patients. J Korean Med Sci. 2016; 31
:1239-45. doi: 10.3346/jkms.2016.31.8.1239. Epub 2016 May 19. PMID: 27478334; PMCID: PMC4951553.
Moon JY, Lee HM, Lee SH, Lee TW, Ihm CG, Jo YI, et al
. Hyperphosphatemia is associated with patency loss of arteriovenous fistula after 1 year of hemodialysis. Kidney Res Clin Pract. 2015; 34
:41-6. doi: 10.1016/j.krcp.2015.02.001. Epub 2015 Feb 23. PMID: 26484018; PMCID: PMC4570653.
Kirkpantur A, Arici M, Altun B, Yilmaz MI, Cil B, Aki T, et al
. Association of serum lipid profile and arteriovenous fistula thrombosis in maintenance hemodialysis patients. Blood Purif. 2008;26:322-32. doi: 10.1159/000132388. Epub 2008 May 19. PMID: 18487877.
Khavanin Zadeh M, Gholipour F, Hadipour R. The effect of hemoglobin level on arteriovenous fistula survival in Iranian hemodialysis patients. J Vasc Access 2008; 9
Tylicki L, Biedunkiewicz B, Nieweglowski T, Grabowska M, Chamienia A, Slizien AD, et al
. Fistula function and dialysis adequacy during ozonotherapy in chronically hemodialyzed patients. Artif Organs. 2004; 28
:513-7. PMID: 15156869.
[Table 1], [Table 2], [Table 3], [Table 4]