Evaluation of platelet indices in chronic kidney disease

Year 2024, , 72 - 79, 02.09.2024

Mahmut Egemen Senel , Ertuğrul Erken , İlyas Ozturk , Neziha Ulusoylar Erken , Orçun Altunören

https://doi.org/10.17944/interdiscip.1462456

Abstract

Objective: Chronic kidney disease (CKD) is characterized by an irreversible decrease in kidney functions and accumulation of uremic toxins in the body. Platelet indices have the potential to predict the inflammatory status and disease progression in patients with CKD. In this study it was aimed to investigate platelet indices and their relations with renal function and comorbid conditions in CKD patients.
Method: In this study it was included 411 CKD patients. We looked for associations between platelet indices and estimated glomerular filtration rate (eGFR). We generated linear regression models for platelet indices that may be associated with eGFR. We evaluated CKD patients for possible associations between platelet indices and comorbid conditions such as diabetes, hypertension, and cardiovascular diseases.
Results: The mean age of CKD patients was 60.5 and the GFR value was 40.1+24.8 mL/min/1.73m2. While the mean platelet count, MPV, PCT, PDW, P-LCR values were lower in the advanced CKD group, hematocrit adjusted platelet count (HAPC), MPV/Lymphocyte ratio and SII parameters were higher in the advanced CKD group (p<0.05 for all). In analyzes a positive correlation was detected between eGFR and HAPC, and a negative correlation was detected between MPV/Lymphocyte ratio and eGFR (p<0.001 and p=0.036). MPV, PCT, PDW, P-LCR and SII index were observed to be higher in diabetic CKD patients (p<0.05 for all).
Conclusion: Platelet indices have the potential to provide valuable data about chronic diseases and their complications. MPV/Lymphocyte ratio and HAPC can give an idea about CKD progression. Our findings suggest that elevations in platelet volume indices could be indicative of diabetic nephropathy and increased inflammatory status.

Keywords

Hematocrit adjusted platelet count, mean platelet volume, platelet indices, systemic immune-inflamation index

References

• Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, et al. Chronic kidney disease and mortality risk: a systematic review. JASN. 2006;17(7):2034-47. https://doi.org/10.1681/ASN.2005101085.
• Lutz P, Jurk K. Platelets in advanced chronic kidney disease: two sides of the coin. Semin Thromb Hemost. 2020;46(3):342-56. https://doi.org/10.1055/s-0040-1708841.
• Kaw D, Malhotra D. Platelet dysfunction and end-stage renal disease. Semin Dial. 2006;19:317-22. https://doi.org/10.1111/j.1525-139X.2006.00179.x.
• Kaushansky K. The molecular mechanisms that control thrombopoiesis. J Clin Invest. 2005;115:12:3339-47. https://doi.org/10.1172/JCI26674.
• Gremmel T, Frelinger AL 3rd, Michelson AD. Platelet physiology. Semin Thromb Hemost. 2016;42(3):191-204.
• Li C, Li J, Li Y, Lang S, Yougbare I, Zhu G, et al. Crosstalk between platelets and the immune system: old systems with new discoveries. Adv Hematol. 2012;2012:384685. https://doi.org/10.1155/2012/384685.
• Briggs C, Harrison P, Machin SJ. Continuing developments with the automated platelet count. Int J Lab Hematol. 2007;29(2):77-91. https://doi.org/10.1111/j.1751-553X.2007.00909.x.
• Sansanayudh N, Numthavaj P, Muntham D, Yamwong S, McEvoy M, Attia J, et al. Prognostic effect of mean platelet volume in patients with coronary artery disease. A systematic review and meta-analysis. Thromb Haemost. 2015;114(6):1299-309. https://doi.org/10.1160/TH15-04-0280.
• Zaccardi F, Rocca B, Pitocco D, Tanese L, Rizzi A, Ghirlanda G. Platelet mean volume, distribution width, and count in type 2 diabetes, impaired fasting glucose, and metabolic syndrome: a meta-analysis. Diabetes Metab Res Rev 2015;31(4):402–10. https://doi.org/10.1002/dmrr.2625.
• Ates I, Bulut M, Ozkayar N, Dede F. Association between high platelet indices and proteinuria in patients with hypertension. Ann Lab Med. 2015;35(6):630-4. https://doi.org/10.3343/alm.2015.35.6.630.
• Noris P, Melazzini F, Balduini CL. New roles for mean platelet volume measurement in the clinical practice? Platelets. 2016;27(7):607-612. https://doi.org/10.1080/09537104.2016.1224828.
• Yu Z, Xiong J, Yang K, Huang Y, He T, Yu Y, et al. The association between platelet indices and cardiovascular events in chronic kidney disease patients without dialysis. Int Urol Nephrol. 2021;53(5):961-71. https://doi.org/10.1007/s11255-020-02696-4.
• Haile K, Kedir R, Timerga A, Mose A, Arkew M. Role of platelet indices as diagnostic and predictive biomarkers for comorbidity of diabetes and metabolic syndrome in southern Ethiopia: A comparative cross-sectional study. PLoS One. 2022;17(11):e0277542. https://doi.org/10.1371/journal.pone.0277542.
• Stevens LA, Schmid CH, Zhang YL, Coresh J, Manzi J, Landis R, et al. Development and validation of GFR-estimating equations using diabetes, transplant and weight. Nephrol Dial Transplant. 2010;25(2):449-57. https://doi.org/10.1093/ndt/gfp510.
• Dorgalaleh A, Mahmudi M, Tabibian S, Khatib ZK, Tamaddon GH, Moghaddam ES, et al. Anemia and thrombocytopenia in acute and chronic renal failure. Int J Hematol Oncol Stem Cell Res. 2013;7(4):34-9.
• Suresh M, Mallikarjuna RN, Sharan B, Singh M, Hari Krishna B, Shravya KG. Hematological changes in chronic renal failure. Int J Sci Res Publ. 2012;2(9):1-4.
• Erken E, Ulgen C, Sarisik FN, Erken N, Gungor O, Altunoren O. Hematological parameters and clinical features in patients with advanced chronic kidney disease. Yonago Acta Med. 2020; 10:63(4):353-9. https://doi.org/10.33160/yam.2020.11.008.
• Yıldız F, Gökmen O. Haematologic indices and disease activity index in primary Sjogren's syndrome. Int J Clin Pract. 2021 Mar;75(3):e13992. https://doi.org/10.1111/ijcp.13992.
• Aashitha M, Chander SK, Muthuvel E. A correlative study of platelet indices in different stages of chronic kidney disease patients in a tertiary care centre. Saudi J Pathol Microbiol. 2021;6(10):375-80. https://doi.org/10.36348/sjpm.2021.v06i10.009.
• Lokesh S, Green SR, Mathew TK, Hemachandar R, Kumar A, Tiwari SR, et al. A comparative study of platelet parameters in end stage renal disease patients undergoing haemodialysis and healthy individuals. IJAM. 2016;3(3):559-63. https://doi.org/10.18203/2349-3933.ijam20162022.
• Ju HY, Kim JK, Hur SM, Woo SA, Park KA, Park MY, et al. Could mean platelet volume be a promising biomarker of progression of chronic kidney disease? Platelets. 2015;26(2):143-7. https://doi.org/10.3109/09537104.2014.890179.
• Tunca O, Kazan S, Kazan ED. Can mean platelet volume predicts renal outcome in acute on chronic kidney disease?. Ther Apher Dial. 2023;27(2):232-9. https://doi.org/10.1111/1744-9987.13935.
• Bozlu G, Akar A, Durak F, Kuyucu N. Role of mean platelet volume-to-lymphocyte ratio in the diagnosis of childhood appendicitis. Función del índice de volumen plaquetario medio/linfocitos en el diagnóstico de la apendicitis durante la niñez. Arch Argent Pediatr. 2019;117(6):375-80. https://doi.org/10.5546/aap.2019.eng.375
• Zorlu C, Koseoglu C. Comparison of the relationship between inflammatory markers and contrast-induced nephropathy in patients with acute coronary syndrome after coronary angiography. Angiology. 2020;71(3):249-55. https://doi.org/10.1177/0003319719892160.
• Xu B, Zhang Y, Chen G, Feng J, Gan L. Association of mean platelet volume/lymphocyte ratio with inflammation in non-dialysis patients with chronic kidney disease stages 1-4: A retrospective study. Front Immunol. 2022;13:1041356. https://doi.org/10.3389/fimmu.2022.1041356.
• Shilpi K, Potekar RM. A study of platelet indices in type 2 Diabetes Mellitus patients. Indian J Hematol Blood Transfus. 2018;34(1):115-20. https://doi.org/10.1007/s12288-017-0825-9.
• Bosco O, Vizio B, Gruden G, Schiavello M, Lorenzati B, Cavallo-Perin P, et al. Thrombopoietin contributes to enhanced platelet activation in patients with type 1 Diabetes Mellitus. Int J Mol Sci. 2021;22(13).7032. https://doi.org/10.3390/ijms22137032.
• Qin Z, Li H, Wang L, Geng J, Yang Q, Su B, et al. Systemic immune-inflammation index is associated with increased urinary albumin excretion: A population-based study. Front Immunol.2022;13:863640. https://doi.org/10.3389/fimmu.2022.863640.
• Li X, Cui L, Xu H. Association between systemic inflammation response index and chronic kidney disease: a population-based study. Front Endocrinol (Lausanne). 2024;15:1329256. https://doi.org/10.3389/fendo.2024.1329256.
• Li M, Zhang J, He Y. Large population study for age- and gender- related variations of platelet indices in Southwest China healthy adults. Hematol Transfus Int J. 2015;1(4):108-14.
• Dupuis M, Severin S, Noirrit-Esclassan E, Arnal JF, Payrastre B, Valéra MC. Effects of estrogens on platelets and megakaryocytes. Int J MolSci.2019;20(12):3111. https://doi.org/10.3390/ijms20123111.
• Schoorl M, Grooteman MP, Bartels PC, Nubé MJ. Aspects of platelet disturbances in haemodialysis patients. Clin Kidney J. 2013;6(3):266-71. https://doi.org/10.1093/ckj/sft033.