An Increase in Mean Platelet Volume/Platelet Count Ratio Is Associated with Vascular Access Failure in Hemodialysis Patients

<div><p>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), <i>P</i>< 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; <i>P</i>< 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 (<i>P</i>< 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.</p></div

Receiver operating characteristic (ROC) curves of Δ(MPV/platelet count ratio)_3mo-baseline for VAF.

<p>Receiver operating characteristic (ROC) curves of Δ(MPV/platelet count ratio)_3mo-baseline for VAF.</p

MPV/platelet count ratio over time in patients with VAF (A) and without VAF (B).

<p>Dash lines represent individual patient measurements, and darker solid lines represent predicted values. The linear mixed model revealed a significantly increased MPV/platelet count ratio over time in patients with VAF (A) compared with patients without VAF (B) (<i>P</i> < 0.001). A row of dots along the bottom of the plot (A) showed the time points at which vascular accesses failed.</p

Correlation between Δ(MPV/P ratio)_3mo-baseline and variables.

<p>Correlation between Δ(MPV/P ratio)_3mo-baseline and variables.</p

Multivariate Cox proportional hazards analysis for VAF (Model 2).

<p>Multivariate Cox proportional hazards analysis for VAF (Model 2).</p

Cox proportional hazards analysis for VAF.

<p>Cox proportional hazards analysis for VAF.</p

Multivariate Cox proportional hazards analysis for VAF.

<p>Multivariate Cox proportional hazards analysis for VAF.</p

Clinical outcomes and general characteristics of patients with idiopathic MN according to anti-PLA₂R reactivity.

<p>The data are expressed as the number (%) or median (25–75% interquartile range) or the mean±SD. MN, membranous nephropathy; Anti-PLA₂R, anti-phospholipase A₂ receptor antibody. eGFR, estimated glomerular filtration rate calculated using the Modification of Diet in Renal Disease formula; uPCR, urine protein-creatinine ratio; RAS blocker, renin angiotensin systemic blocker.</p

Clinical characteristics of patients with idiopathic MN at the time of kidney biopsy according to anti-PLA₂R reactivity.

<p>The data are expressed as the mean±SD or median (25–75% interquartile range). MN, membranous nephropathy; Anti-PLA₂R, anti-phospholipase A2 receptor antibody; eGFR, estimated glomerular filtration rate calculated using the Modification of Diet in Renal Disease formula; uPCR, urine protein-creatinine ratio; RAS blocker, renin angiotensin systemic blocker.</p

Baseline demographics, clinical characteristics, and biochemical variables according to the occurrence of VAF.

<p>Baseline demographics, clinical characteristics, and biochemical variables according to the occurrence of VAF.</p