Study of platelet indices as markers of cardiovascular risk in patients of chronic kidney disease

Background: Chronic kidney disease (CKD) is now recognized as a leading public health burden with a prevalence of approximately 13.4%. Cardiovascular disease is the most common cause of mortality in CKD patients before reaching ESRD. Hence early detection of the cardiovascular disease in CKD is of paramount importance in order to reduce mortality in CKD patients. As platelet activation results in thrombosis, hence platelet indices are indicators of platelet activation and marker of thrombotic events and development of cardiovascular disease.
Objectives: To study the various platelet indices (TPC,MPV,PDW,PCT and PLCR) and cardiovascular diseases in CKD patients and correlation between them.
Materials and methods: We performed a single-centre analytical cross-sectional study involving 230 CKD patients admitted in General Medicine and Nephrology wards of VIMSAR, Burla over a period of 2 years to explore the relationship between platelet indices and CVD events in CKD patients Patients were categorised into various stages after GFR estimation with CKD-EPI equation. The association of platelet indices and the various cardiovascular diseases in CKD was then evaluated by various tables, graphs and charts. Finally ROC curves were applied to evaluate the predictive accuracy of platelet indices on CVD risk in CKD patients.
Results: During our 2 years study period,158(68.6%) out of the 230 CKD had developed CVD and abnormal platelet indices was found in 55.2% of CKD patients. Results showed that TPC,MPV and PDW were significantly associated with overall development of CV events in CKD patients(p values of 0.001,<0.001,<0.001 respectively). MPV was the most predictive and early indicator of the risk of development of various cardiovascular disease in CKD followed by PDW,TPC,PCT and PLCR.
Conclusion: We demonstrated that TPC,MPV and PDW were independently associated with CVD in CKD patients. PCT was independently associated with HTN in CKD patients. MPV, PDW, PCT and PLCR were independently associated with MI in CKD patients. MPV and PDW were independently associated with DCM in CKD patients. MPV was the best and earliest indicator of CVD risk in CKD patients.