In Vitro Closure Times (PFA-100) Are Different Between Peritoneal Dialysis and Hemodialysis

Cenk Gokalp; Fatma Keklik Karadag; Matthias Christoph Braunisch; Christoph Schmaderer; Emrah Gunay; Hatice Demet Kiper; Mahmut Tobu; Celalettin Ustün; Meltem Sezis Demirci; Mehmet Ozkahya

doi:10.1055/a-1171-0499

Hämostaseologie, Table of Contents

Hamostaseologie 2020; 40(05): 671-678
DOI: 10.1055/a-1171-0499

Original Article

In Vitro Closure Times (PFA-100) Are Different Between Peritoneal Dialysis and Hemodialysis

Cenk Gokalp

¹Department of Nephrology, Ege University, İzmir, Turkey

,

Fatma Keklik Karadag

²Department of Internal Medicine, Ege University, İzmir, Turkey

,

Matthias Christoph Braunisch

³Department of Nephrology, KlinikumRechts der Isar, School of Medicine, Technical University Munich, Munich, Germany

,

Christoph Schmaderer

³Department of Nephrology, KlinikumRechts der Isar, School of Medicine, Technical University Munich, Munich, Germany

,

Emrah Gunay

¹Department of Nephrology, Ege University, İzmir, Turkey

,

Hatice Demet Kiper

⁴Department of Hematology, Ege University, İzmir, Turkey

,

Mahmut Tobu

⁴Department of Hematology, Ege University, İzmir, Turkey

,

Celalettin Ustün

⁵Department of Hematology, University of Minnesota, Minnesota, United States

,

Meltem Sezis Demirci

¹Department of Nephrology, Ege University, İzmir, Turkey

,

Mehmet Ozkahya

¹Department of Nephrology, Ege University, İzmir, Turkey

› Author Affiliations

Abstract

Introduction Platelet dysfunction is not uncommon in patients with end-stage renal disease (ESRD). Type of renal replacement therapy may have an effect on platelet functions, which has not been well investigated. We evaluated in vitro closure time (CT) differences between peritoneal dialysis (PD) and hemodialysis (HD) patients using platelet function analyzer (PFA-100)and observed a significant difference between these renal replacement therapies.

Methods Patients with ESRD undergoing PD (n = 24) or HD (n = 23) for more than 6 months were included. Blood samples for collagen/epinephrine (Col/EPI) and collagen/adenosine diphosphate (Col/ADP) measurements were obtained before HD at a mid-week session for HD patients and at an outpatient control time for PD patients.

Results Three of 24 (12.5%) PD patients and 16 of 23 (69.5%) HD patients had prolonged PFA-100 Col/EPI, p< 0.001. Likewise, 4.2% of PD patients and 87.0% of HD patients had prolonged PFA-100 Col/ADP, p< 0.001. Moreover, the median times of PFA-Col/EPI and PFA-100 Col/ADP were significantly lower in PD patients compared with those of HD patients (p< 0.001). Multivariate analysis showed that the type of renal replacement was a risk factor for both elevated PFA-100 Col/ADP and PFA-100 Col/EPI after adjusted for platelets, hematocrit, and urea (p< 0.001).

Conclusions The type of renal replacement therapy may have an effect on in vitro CTs; therefore, studies including more patients with long-term follow-up are needed to investigate if the difference has any impact on clinical outcomes.

Zusammenfassung

Eine Thrombozytendysfunktion ist bei Dialysepatienten nicht selten. Unklar ist inwieweit das Dialyseverfahren einen Einfluss auf die Thrombozytenfunktion hat. Wir untersuchten die in vitro Verschlusszeit mittels PFA-100 bei n = 24 Patienten mit Peritonealdialyse (PD) und n = 23 Patienten mit Hämodialyse (HD). Blutproben zu Messung von Kollagen/Adrenalin (Col/EPI) und Kollagen/ADP (Col/ADP) wurden bei HD-Patienten vor einer in der Mitte der Woche stattfindenden Dialysesitzung und bei PD-Patienten zur ambulanten Visite abgenommen. 13% der PD- und 70% der HD-Patienten hatten eine verlängerte PFA-100 Col/EPI. Ebenso lag bei 4% der PD- und 87% der HD-Patienten eine verlängerte PFA-100 Col/ADP vor. Gleichermaßen waren die medianen Verschlusszeiten von PFA-100 Col/EPI und Col/ADP bei PD- im Vergleich zu HD-Patienten signifikant niedriger. Nach Adjustierung blieb das Dialyseverfahren ein Risikofaktor sowohl für eine erhöhte PFA-100 Col/EPI als auch für eine PFA-100 Col/ADP. Weitere Studien sind notwendig um zu evaluieren, ob dieser Unterschied einen langfristigen Einfluss auf das klinische Outcome hat.

Keywords

in vitro closure time - hemodialysis - peritoneal dialysis - thrombocyte function - primary hemostasis

Schlüsselwörter

in vitro Verschlusszeit - Hämodialyse - Peritonealdialyse - Thrombozytenfunktion - primäreHämostase

Full Text

References

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