Korean J Intern Med.  2019 Nov;34(6):1304-1312. 10.3904/kjim.2018.111.

Effects of aspirin resistance and mean platelet volume on vascular access failure in hemodialysis patients

• Cho A
• Choi MJ
• Lee YK
• Hoon HC
• Koo JR
• Yoon JW
• Noh JW

• KMID: 2463489
• DOI: http://doi.org/10.3904/kjim.2018.111

Abstract

BACKGROUND/AIMS
Maintaining the patency of vascular access (VA) in hemodialysis (HD) patients is important and can be life-saving. We investigated the effects of aspirin resistance and mean platelet volume (MPV) on VA failure in HD patients.
METHODS
We enrolled 163 patients on maintenance HD. VA failure was defined as thrombosis or a decrease of > 50% of the normal vessel diameter, as revealed by angiography.
RESULTS
Aspirin resistance was observed in 17 of 109 patients in whom this parameter was measured, and was not significantly associated with VA failure (p = 0.051). The mean MPV was 9.15 ± 0.05 fL. The 163 patients were grouped by the median MPV value (9.08 fL) at baseline; patients with higher MPVs (n = 82) had lower platelet counts (p = 0.002) and albumin levels (p = 0.009). During 34 months of follow-up, 65 VA failures (39.9%) occurred. The Kaplan-Meier curve revealed significant differences between the two groups in terms of cumulative VA failure (54.1% vs. 35.3%, p = 0.018). On multivariate analysis, the MPV (hazard ratio [HR], 1.794; 95% confidence interval [CI], 1.066 to 3.020; p = 0.028), platelet count (HR, 1.003; 95% CI, 1.001 to 1.006; p = 0.01), and smoking status (HR, 1.894; 95% CI, 1.019 to 3.519; p = 0.043) independently predicted VA failure.
CONCLUSIONS
A high MPV was associated with an increased risk of VA failure, whereas aspirin resistance showed only a weak association. The MPV may predict VA survival in HD patients.

Keyword

Mean platelet volume; Aspirin resistance; Renal dialysis; Vascular access

MeSH Terms

Angiography
Aspirin*
Follow-Up Studies
Humans
Mean Platelet Volume*
Multivariate Analysis
Platelet Count
Renal Dialysis*
Smoke
Smoking
Thrombosis
Aspirin
Smoke