Platelet Activity and Cardiovascular Risk in CKD and Peripheral Artery Disease

CKD Effects on Platelets: Implications for Cardiovascular Risk

“…Modest, significant negative correlations were observed by the authors between eGFR and platelet aggregation upon stimulation with the above-mentioned agonists at specific doses. Yet, when directly comparing patients in CKD stage 4-5 (eGFR<30) with patients in CKD stage 3, CKD4-5 patients did not present a higher platelet aggregatory response to most of the investigated agonists 6 . On the other hand, Huang et al previously reported increased platelet aggregatory responses upon ADP stimulation in nondialysis CKD5 compared to controls and CKD3 patients, but not in CKD3 or CKD4 patients compared to controls 9 .…”

“…Whereas only a small number of patients were diagnozed with diabetes in the study of Huang et al (5% of controls vs. 11% of non-dialysis CKD5) 9 , a significantly higher number of CKD patients in the study of Cofer et al 6 also suffered from diabetes (69%; compared to only 41.9% in the non-CKD group), with diabetes associated with a higher platelet reactivity 1 . Also, most of the patients in the study of Cofer et al 6 were on antiplatelet therapy, with 79.6% / 82.6% on aspirin and 37.2% / 44.2% on clopidogrel for CKD and control patients respectively, without significant differences between both groups 6 . Whereas clopidogrel is an irreversible antagonist of P2Y12 as receptor for ADP, aspirin inhibits thromboxane A2 production.…”

“…Patient heterogeneity in terms of disease severity could have contributed to these conflicting findings in platelet responses in literature. CKD is a progressive disease and also cardiovascular risk increases with increasing kidney dysfunction 3 , as confirmed by Cofer et al 6 . Modest, significant negative correlations were observed by the authors between eGFR and platelet aggregation upon stimulation with the above-mentioned agonists at specific doses.…”

“…Potential factors contributing to this variability in results could include differences in studied patient cohorts in terms of comorbidities or therapy. The study in this issue focussed specifically on patients with PAD undergoing revascularization and included CKD4-5 patients who were for 60% on dialysis 6 , whereas Huang et al studied non-dialysis patients only 9 . Whereas only a small number of patients were diagnozed with diabetes in the study of Huang et al (5% of controls vs. 11% of non-dialysis CKD5) 9 , a significantly higher number of CKD patients in the study of Cofer et al 6 also suffered from diabetes (69%; compared to only 41.9% in the non-CKD group), with diabetes associated with a higher platelet reactivity 1 .…”

“…The study in this issue focussed specifically on patients with PAD undergoing revascularization and included CKD4-5 patients who were for 60% on dialysis 6 , whereas Huang et al studied non-dialysis patients only 9 . Whereas only a small number of patients were diagnozed with diabetes in the study of Huang et al (5% of controls vs. 11% of non-dialysis CKD5) 9 , a significantly higher number of CKD patients in the study of Cofer et al 6 also suffered from diabetes (69%; compared to only 41.9% in the non-CKD group), with diabetes associated with a higher platelet reactivity 1 . Also, most of the patients in the study of Cofer et al 6 were on antiplatelet therapy, with 79.6% / 82.6% on aspirin and 37.2% / 44.2% on clopidogrel for CKD and control patients respectively, without significant differences between both groups 6 .…”