Bonell Vera, Schmaderer Christoph, Lorenz Georg, Günthner Roman, Angermann Susanne, Bachmann Quirin, Küchle Claudius, Renders Lutz, Heemann Uwe, Kessler Thorsten, Kemmner Stephan
Department of Nephrology, Klinikum Rechts der Isar, TUM University Hospital, TUM School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany.
Reparto di Nefrologia e Dialisi, Ospedale Centrale di Bolzano, 39100 Bolzano, Italy.
J Clin Med. 2025 Jul 21;14(14):5156. doi: 10.3390/jcm14145156.
Coagulation disorders, including both bleeding and thrombotic complications, are common in patients undergoing hemodialysis (HD). Here, we aimed to characterize platelet function in patients undergoing hemodialysis three times per week, compared to healthy controls. Platelet function was assessed using the Multiplate analyzer (Roche), which is based on multiple electrode impedance aggregometry. Platelet aggregation was induced using adenosine diphosphate (ADP), and the area under the curve (AUC) served as the primary endpoint. In addition, platelet counts and C-reactive protein (CRP) levels were measured. To further evaluate nitric oxide (NO)-mediated inhibition of platelet aggregation, blood samples were incubated with the NO donor, sodium nitroprusside (SNP), and the phosphodiesterase 5A (PDE5A) inhibitor, sildenafil. A total of 60 patients undergoing HD and 67 healthy controls were included in the analysis. Patients receiving HD treatment had significantly lower platelet counts compared to healthy controls (226.9 ± 53.47 vs. 246.7 ± 47.21 G/L, = 0.029). Platelet aggregation was markedly reduced in patients undergoing HD compared to controls (462.0 ± 266.54 vs. 644.5 ± 254.44 AU × min, < 0.001) with a significant correlation for platelet count (r = 0.42, = 0.001) and systemic inflammation as indicated by CRP levels (r = 0.28, = 0.035). Following SNP and sildenafil administration, inhibition of platelet aggregation remained more pronounced in patients undergoing HD. However, the change in platelet aggregation after SNP/sildenafil treatment did not differ significantly between the groups. : Patients undergoing HD exhibit altered platelet function, indicated by reduced aggregation and platelet counts, as well as an association with systemic inflammation. Multiple electrode impedance aggregometry appears to be a feasible method for detecting platelet function alterations in patients receiving HD treatment. Responsiveness to NO donors was preserved in patients undergoing HD. Further studies are needed to identify the underlying mechanisms, particularly the role of NO signaling in platelet dysfunction in patients undergoing HD.
凝血功能障碍，包括出血和血栓形成并发症，在接受血液透析（HD）的患者中很常见。在此，我们旨在描述每周进行三次血液透析的患者与健康对照相比的血小板功能特征。使用基于多电极阻抗聚集法的Multiplate分析仪（罗氏公司）评估血小板功能。使用二磷酸腺苷（ADP）诱导血小板聚集，曲线下面积（AUC）作为主要终点。此外，还测量了血小板计数和C反应蛋白（CRP）水平。为了进一步评估一氧化氮（NO）介导的血小板聚集抑制作用，将血样与NO供体硝普钠（SNP）和磷酸二酯酶5A（PDE5A）抑制剂西地那非一起孵育。分析共纳入60例接受血液透析的患者和67例健康对照。接受血液透析治疗的患者血小板计数明显低于健康对照（226.9±53.47对246.7±47.21 G/L，P = 0.029）。与对照组相比，接受血液透析的患者血小板聚集明显降低（462.0±266.54对644.5±254.44 AU×min，P<0.001），与血小板计数（r = 0.42，P = 0.001）和CRP水平所表明的全身炎症显著相关（r = 0.28，P = 0.035）。给予SNP和西地那非后，接受血液透析的患者血小板聚集抑制作用仍然更明显。然而，SNP/西地那非治疗后血小板聚集的变化在两组之间没有显著差异。结论：接受血液透析的患者表现出血小板功能改变，表现为聚集和血小板计数降低，以及与全身炎症相关。多电极阻抗聚集法似乎是检测接受血液透析治疗患者血小板功能改变的一种可行方法。接受血液透析的患者对NO供体的反应性得以保留。需要进一步研究以确定潜在机制，特别是NO信号在接受血液透析患者血小板功能障碍中的作用。
