İDAME HEMODİYALİZ HASTALARINDA ORTALAMA TROMBOSİT HACMİ'NİN MORTALİTE ÜZERİNE ETKİSİ

AMAÇ: Hemodiyaliz son dönem böbrek hastalığı olan hastalarda en sık tercih edilen renal replasman tedavisi tipidir. İdame hemodiyaliz tedavisi alan hastalarda mortaliteyi etkileyen parametrelerin bilinmesi bu hasta grubunda sağkalımı artırabilir. Ortalama trombosit hacmi (MPV) tam kan sayımı parametrelerinden biridir. MPV yüksekliğinin birçok hastalıkta mortaliteyi artırabileceği gösterilmiştir. Bu çalışmamızda idame hemodiyaliz hastalarında MPV’nin mortalite üzerine etkisini araştırmayı amaçladık. GEREÇ VE YÖNTEM: Ocak 2010 ve Ocak 2020 tarihleri arasında hastanemizde idame diyaliz tedavisine başlanan tüm hastaların dosyaları retrospektif olarak tarandı. Hastaların demografik verileri ve laboratuar parametrelerine hasta dosyalarından ulaşıldı. MPV değeri için idame diyaliz tedavisi başlanan ilk 3 ay rutin bakılan tam kan sayımındaki MPV değerlerinin ortalaması alındı. Takip süresince ölen ve yaşayan hastalar MPV değerleri açısından karşılaştırıldı. BULGULAR: Çalışma 129 hasta ile yapıldı. Hastaların %24.8’i (n= 32) takipler süresince ölmüştü. Ölen hastaların MPV’si yaşayan hastalara göre anlamlı şekilde daha yüksekti (11.14±1’e karşı 10.12±0.8, p<0.001). Mortaliteyi öngörmek açısından en iyi MPV değeri 10.73 olarak bulundu (%75 sensitivite ve %81.4 spesifisite ile). SONUÇ: Yüksek MPV idame hemodiyaliz hastalarında mortalite için bağımsız bir risk faktörüdür. MPV’si yüksek olan hemodiyaliz hastalarında değiştirilebilir risk faktörlerinin daha sıkı yönetilmesi sağkalımlarını artırabilir.

Anahtar Kelimeler:

Hemodiyaliz, Mortalite, Ortalama trombosit hacmi

EFFECT OF MEAN PLATELET VOLUME ON MORTALITY IN MAINTENANCE HEMODIALYSIS PATIENTS

OBJECTIVE: Hemodialysis is the most preferred type of renal replacement therapy in patients with end-stage renal disease. Knowing the parameters affecting mortality in patients receiving maintenance hemodialysis treatment may increase the survival rate in this patient group. Mean platelet volume (MPV) is one of the parameters of the complete blood count. It has been shown that high MPV can increase the mortality rate in many diseases. In this study, we aimed to investigate the effect of MPV on the mortality rate in maintenance hemodialysis patients. MATERIAL AND METHODS: The files of all patients who were started on maintenance dialysis treatment in our hospital between January 2010 and January 2020 were reviewed retrospectively. Demographic data and laboratory parameters of the patients were obtained from the patient files. For the MPV value, the mean of the MPV values in the routine complete blood count for the first 3 months after maintenance dialysis treatment was started. Patients who died and survived during the follow-up were compared in terms of MPV values. RESULTS: The study was conducted with 129 patients. 24.8% (n= 32) of the patients died during follow-up. MPV of deceased patients was significantly higher than survived patients (11.14±1 vs. 10.12±0.8, p<0.001). The best MPV value for predicting mortality was found to be 10.73 (with 75% sensitivity and 81.4% specificity). CONCLUSIONS: High MPV is an independent risk factor for mortality in maintenance hemodialysis patients. Tighter management of modifiable risk factors in hemodialysis patients with high MPV may improve their survival.

Keywords:

Hemodialysis, Mortality, Mean platelet volume,

PDF

___

1. Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet. 2017;389(10075):1238-52.
2. Seyahi N, Kocyigit I, Ates K, Suleymanlar G. Current Status of Renal Replacement Therapy in Turkey: A Summary of 2020 Turkish Society of Nephrology Registry Report. Turkish Journal of Nephrology. 2022;31:103–9.
3. De Arriba G, Gutiérrez Avila G, Torres Guinea M, et al. La mortalidad de los pacientes en hemodiálisis está asociada con su situación clínica al comienzo del tratamiento. Nefrología. 2021;41(4):461–6.
4. Ma L, Zhao S. Risk factors for mortality in patients undergoing hemodialysis: A systematic review and meta-analysis. International Journal of Cardiology. 2017;238:151–8.
5. Erdoğmuş Ş, Kaymakamtorunları F. Factors Associated with Mortality in Maintenance Hemodialysis Patients: A Single-Center Data from East Anatolian Region of Turkey. Journal of Ankara University Faculty of Medicine. 2020;73(3):239–46.
6. Sansanayudh N, Anothaisintawee T, Muntham D, McEvoy M, Attia J, Thakkinstian A. Mean platelet volume and coronary artery disease: A systematic review and meta-analysis. International Journal of Cardiology. 2014;175(3):433–40.
7. Sun XP, Li BY, Li J, Zhu WW, Hua Q. Impact of Mean Platelet Volume on Long-Term Mortality in Chinese Patients with ST-Elevation Myocardial Infarction. Scientific Reports. 2016;6:21350.
8. Tajarernmuang P, Phrommintikul A, Limsukon A, Pothirat C, Chittawatanarat K. The Role of Mean Platelet Volume as a Predictor of Mortality in Critically Ill Patients: A Systematic Review and Meta-Analysis. 2016;2016:4370834.
9. Chen Z, Li N, Wang J, et al. Association between mean platelet volume and major adverse cardiac events in percutaneous coronary interventions: A systematic review and meta-analysis. Coronary Artery Disease. Lippincott Williams and Wilkins. 2020;31(8):722-32.
10. Henning BF, Zidek W, Linder B, Tepel M, Henning BF. Mean Platelet Volume and Coronary Heart Disease in Hemodialysis Patients. Kidney Blood Pressure Res. 2002;25(2):103-108.
11. Chu SG, Becker RC, Berger PB, et al. Mean platelet volume as a predictor of cardiovascular risk: A systematic review and meta-analysis. Journal of Thrombosis and Haemostasis. 2010;8(1):148–56.
12. Pafili K, Penlioglou T, Mikhailidis DP, Papanas N. Mean platelet volume and coronary artery disease. Current Opinion in Cardiology. 2019;34(4):390-98.
13. Zampieri FG, Ranzani OT, Sabatoski V, et al. An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients. Annals of Intensive Care. 2014;4(1):1–8.
14. Chen J, Li Y, Zeng Y, Tian Y, Wen Y, Wang Z. High Mean Platelet Volume Associates with In-Hospital Mortality in Severe Pneumonia Patients. Mediators of Inflammation. 2020;2020:8720535.
15. Kim S, Molnar MZ, Fonarow GC, et al. Mean platelet volume and mortality risk in a national incident hemodialysis cohort. International Journal of Cardiology. 2016;220:862–70.
16. Astor BC, Eustace JA, Powe NR, et al. Type of vascular access and survival among incident hemodialysis patients: The choices for healthy outcomes in caring for ESRD (CHOICE) study. Journal of the American Society of Nephrology. 2005;16(5):1449–55.
17. Pisoni RL, Arrington CJ, Albert JaM, et al. Facility Hemodialysis Vascular Access Use and Mortality in Countries Participating in DOPPS: An Instrumental Variable Analysis. American Journal of Kidney Diseases. 2009;53(3):475–91.
18. Lewington S, Clarke R, Qizilbash N, et al. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903-13.
19. Foley RN, Parfrey PS, Harnett JD, et al. Impact of hypertension on cardiomyopathy, morbidity and mortality in end-stage renal disease. Kidney International. 1996;49(5):1379–85.
20. Lipton R, Cunradi C, Chen MJ. Smoking and all-cause mortality among a cohort of urban transit operators. Journal of Urban Health. 2008;85(5):759-65.
21. Gellert C, Schöttker B, Brenner H. Smoking and All-Cause Mortality in Older People Systematic Review and Meta-analysis. Arch Intern Med. 2012;172(11):837-44.
22. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: An update. Journal of the American College of Cardiology. 2004;43(10):1731-7.
23. Li NC, Thadhani RI, Reviriego-Mendoza M, Larkin JW, Maddux FW, Ofsthun NJ. Association of Smoking Status With Mortality and Hospitalization in Hemodialysis Patients. Am J Kidney Dis. 2018;72(5):673-81.
24. Mc Causland FR, Brunelli SM, Waikar SS. Association of smoking with cardiovascular and infection-related morbidity and mortality in chronic hemodialysis. Clinical Journal of the American Society of Nephrology. 2012;7(11):1827–35.
25.Yayar E, Eser B, Bicakci F, Ayli MD. Is mean platelet volume a predictor of atherosclerosis in hemodialysis patients? J Turgut Ozal Med Cent. 2017;24(4):430-3.