Vascular disease outcome and thrombocytosis in diabetic and nondiabetic end-stage renal disease patients on peritoneal dialysis.

STUDY OBJECTIVE

to evaluate vascular disease and its outcome in association with thrombocytosis in chronic peritoneal dialysis (PD) patients.

DESIGN

the study was designed to investigate possible correlations between severity of vascular disease and thrombocytosis in PD patients.

SETTING

tertiary-referral university hospital.

PATIENTS AND METHODS

serial blood platelet levels were measured in 53 stable PD patients (32 male, 21 female; mean age 55 years; mean duration of PD 19 months) between January 1991 and July 1992. Twenty-four patients were diabetic and 29 were nondiabetic. Mean duration of PD was 23 and 36 months in diabetic and nondiabetic patients, respectively. Severity of coronary arterial disease (CAD), carotid arterial disease (CNS), and peripheral arterial disease (PAD) was assessed using the Craven et al. (1991) ESRD Severity Index, a measure of organ dysfunction. Functional status was assessed using the Karnofsky Performance Status Index (KPSI).

RESULTS

eighteen out of 53 PD patients (34%) had platelet counts exceeding 300,000/mm3 for six months or longer. Thirteen of 24 diabetic PD patients (54%) had thrombocytosis. Blood platelets were significantly (p < 0.01) higher in diabetic (324,000 +/- 27,000/mm3) than in nondiabetic PD (236,000 +/- 11,000/mm3) patients. In the PD group as a whole, a positive correlation was observed between blood platelet and serum cholesterol (r = 0.5, p < 0.001), blood platelet and PAD (r = 0.5, p < 0.001), and blood platelet and CAD (r = 0.35, p < 0.05). No correlation was found with age or duration of PD. In diabetic PD patients, blood platelet counts correlated significantly with PAD (r = +0.5, p < 0.01) and CAD (r = +0.4, p < 0.05) indexes. No correlation was observed between blood platelet and CNS or KPS indexes. In nondiabetics, no correlation was observed between blood platelet and CAD, PAD, CNS, or KPS indexes. CAD, PAD, and KPS indexes were significantly higher in diabetics compared to nondiabetics.

CONCLUSIONS

thrombocytosis, particularly in diabetic PD patients, appears to be associated with the severity of PAD and CAD.