Mean Platelet Volume/Platelet Count Ratio as Screening for Vascular Access Failure in Children on Regular Hemodialysis

Abstract

Background: Successful hemodialysis depends on the provision of safe, efficient and durable vascular access. Establishing and maintaining effective Vascular Access (VA) is a demanding process for both patients and renal services.The mean platelet volume (MPV) is a laboratory marker associated with platelet function and activity The ease and low cost of MPV testing suggest that it may be useful to predict the risk of vascular thrombosis. Aim of study:This work aims to assess the feasibility of mean platelet volume/platelet count ratio as screening tool for vascular access failure in children on regular hemodialysis (HD).
Subjects and Methods: The present study was a cross-sectional study that included 48 children on regular HD. The children were recruited from the Nephrology Unit, Children's Hospital of Zagazig University from March 2018 till February 2019.All patients have been subjected to the following:A-Full history taking.B-General examination: with special consideration to blood pressure and heart rate. C- Access examination: to examine its pulsation, thrill and signs of inflammation as hotness and redness.D-Doppler ultrasound: It was done for all the patients with arteriovenous fistulas or graft to detect their patency and any chronic complication like aneurysmal dilatation.E-Laboratory Investigations:Mean platelet volume, Platelet count, Mean platelet volume/platelet count ratio, Bun and serum creatinine, Calcium &phosphorus product. Results:The mean age of the included patients was 11.20 ± 3.38 years and the majority of patients were females (56.2%).Ninety-five percent of the patients had thrill in vascular access and 18.8% had weak pulsation. In addition, 56.3% of the patients had signs of inflammation in the form of redness (100%), swelling (62.2%), and/or pain (37.1%).Three patients (6.3%) had Thrombosis& Stenosis& Aneurysm, 10 (20.8%) had Stenosis& Aneurysm, and 5 (10.4%) patients had aneurysm only meaning that18 patient (37.5 %) had Doppler finding.MPV changed significantly from August 2018 to January 2019 to decrease to 212.9 ± 99.07 x106/mL, MPV increased significantly fromAugust 2018 to January 2019 to reach 9.18 ± 0.77fL. Consequently, MPV/platelet count ratio increased significantly from August 2018 to January 2019 to reach 0.06 ± 0.08.There were statistically significant associations between the presence of thrombosis in Doppler and platelet volume in March 2018 (p =0.048) and January 2019 (p =0.006).There were statistically significant associations between the presence of aneurysm in Doppler and platelet volume in January 2019(p =0.023).There were no statistically significant associations between the Age of the working vascular access (months) and thrombosis in Doppler. In contrary, there were statistically significant associations between the Age of the working vascular access (months) and both stenosis and aneurysm.
Conclusion:Mean platelet volume /platelet count ratio is a promising screening tool for vascular access failure in pediatric patients on regular HD. It is an easy and accessible tool to approach the reactivity of platelets in HD patients. Our study showed that an increase in mean platelet volume /platelet count ratio over time was an independent risk factor for vascular access failure.