The role of platelets activation and other factors In vascular access failure in hemodialysis patients

Abstract EN

Introduction : Vascular access (VA) complications are the main causes of morbidity and hospitalization in hemodialysis (HD) patients.

The most common complication of VA is dysfunction or failure due to stenosis or thrombosis.

Aim : This work aimed to assess the relationship between platelets activation and other factors in VA failure in HD patients.

Methods: Thirty HD patients were divided into 2 groups.

Group A comprised 15 patients with recurrent VA failure, Group B comprised 15 patients whose fistulae were normally functioning for > 5 years.

All cases were subjected to: -Full clinical assessment with special stress on history of recurrent hypotensive attacks during dialysis (RHA), erythropoietin therapy and signs of VA failure.

- Laboratory investigations including: Complete blood cell count (CBC) and measurement of hematocrit value and erythrocyte sedimentation rate (ESR).

Kt / V, serum lipid profile, serum albumin, Pselectin and plasma fibrinogen levels was measured.

-Doppler ultrasound examination of VA to assess its patency and to measure VA blood flow rate was carried out.

Results : Group A had significantly higher number of RHA, lower Kt / V and higher serum triglycerides levels.

There was no significant statistical difference between the two groups as regards history of erythropoietin therapy, CBC, hematocrite value, ESR, total cholesterol, LDL-cholesterol and HDL-cholesterol.

Group A had significantly lower serum albumin levels, higher serum P-selectin levels, and higher plasma fibrinogen levels.

Serum albumin was directly correlated with the average duration of VA and inversely correlated with serum P-selection and plasma fibrinogen levels.

Serum P-selectin was inversely correlated with average duration of VA.

Doppler blood flow rate of VA was significantly lower in group A with venous stenosis in 5 patients, partial venous thrombosis in 5 patients and complete venous thrombosis in 2 patients.

Conclusion : We concluded that : RHA, Hypertriglyceridemia, hypo-albuminemia and hyper-fibrinogenemia play a role in recurrent VA failure.

Patients with recurrent VA failure had increased platelets activation as evidenced by high P-selectin level.

Treatment of patients with recurrent VA thrombosis with anti-platelet agent may help to prevent recurrence of VA failure.

Correction of malnutrition, treatment of hyperlipidemia, prevention of RHA, and frequent Doppler ultrasound examination of VA are recommended.