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Platelet Adhesion Testing May Predict Early Hemodialysis Arteriovenous Graft and Fistula Failure in End-Stage Renal Disease Patients

Vascular access thrombosis (VAT) is the most morbid and costly complication in end-stage renal disease (ESRD) patients. Although hypercoagulability is a major risk factor for VAT, in most patients, the cause of hypercoagulability cannot be identified despite clinical suspicion. In this study, platelet hyperreactivity was investigated for a possible role in the hypercoagulability of ESRD and VAT in 42 patients with arteriovenous (AV) grafts or fistulas. Platelet adhesion, platelet aggregation, and the history of VAT were assessed. The statistics included a nonparametric 2-factor ANOVA, a Mann-Whitney analysis, and a Kaplan-Meier analysis of hemodialysis angioaccess survival to examine platelet hyperadhesiveness as a predictor of access survival. The study showed a significant correlation between increased platelet adhesiveness and shortened survival of the primary hemodialysis angioaccess. Collagen-induced platelet aggregation reflected a significantly higher response in those with shortened access survival. These findings may have significant clinical implications for risk assessment and prevention of VAT.