Kidney Week

Abstract: FR-PO737

Effect of a Hemodialysis Treatment on Platelet Function Using PFA-100

Session Information

• Dialysis: Inflammation and Infection
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Patel, Komal, Northwell Health Lenox Hill Hospital, Paramus, New Jersey, United States

Komal Patel,

• Rosenstock, Jordan L., Northwell Health Lenox Hill Hospital, Paramus, New Jersey, United States

Jordan L. Rosenstock,

• DeVita, Maria V., Lenox Hill Hospital- Northwell Health System, New York, New York, United States

Maria V. DeVita,

• Zaman, Warda, Northwell Lenox Hill Hospital, New York, New York, United States

Warda Zaman,

Background

Platelet dysfunction is well known to be present in patients with end-stage renal disease (ESRD). Various tests have been used to assess platelet function in patients with ESRD, but few studies involve the platelet function analyzer (PFA-100). PFA-100 is more accurate in assessing platelet function compared to prior methods such as skin bleeding time and platelet aggregation. The purpose of this study was to show the effect of a hemodialysis (HD) session on platelet function in a patient with ESRD on chronic HD.

Methods

The study enrolled 16 patients undergoing chronic HD three times a week from a single unit. Exclusion criteria were hemoglobin < 9 mg/dL, thrombocytopenia and the use of antiplatelet agents. Blood was drawn prior to and after HD after the long interdialytic period, and sent for PFA-100 analysis. Heparin was held during the treatment. PFA -100 measured both the collagen /epinephrine (COL/EPI) and collagen/ ADP (COL/ ADP) closure times in seconds.

Results

Pre-HD, 11 (69%) started with an abnormal COL/EPI of which none normalized. Of the 5 patients that started with a normal COL/EPI, 1 developed an abnormal COL/EPI post-HD. Pre-HD, 11 (69%) started with an abnormal COL/ADP of which one normalized. Of the 5 patients that started with a normal COL/ADP, 4 patients developed an abnormal COL/ADP post-HD. Overall post-HD, there was an increase in COL/EPI closure time in 11 (69%), no change in 2 (12%), and decrease in 3 (19%) patients. There was an increase in COL/ADP in 12 (75%) , no change in 1 (6%), and decrease in 3 (19%) of patients. Only one patient who originally had an abnormal PFA test, had normalization of the PFA- 100 after a HD treatment.

Conclusion

This study found that the majority of regularly dialyzed patients in our population had abnormal platelet function as measured by the PFA -100 analyzer after the long interdialytic interval. Only one patient had normalization a abnormal PFA-100 after a HD treatment. Most patients appeared to have worsening of platelet function as indicated by a longer closure time. This could be due to an interaction with the dialyzer membrane. Our findings don't support a common practice of performing a HD treatment prior to surgical procedures in order to help avoid bleeding complications. This study involved a small cohort of patients from a single HD unit, a larger multi-centered trial is warranted to confirm results.