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Kidney Week

Abstract: PO0184

Severe Kidney Injury Requiring Continuous Renal Replacement Therapy: Correlation of Mean Platelet Volume with Mortality at Multiple Time Intervals

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Pickthorn, Sean, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Hocker, Nathaniel, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Mann, Lewis, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Venkatasubramanian, Ravinandan, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Sambharia, Meenakshi, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Nizar, Jonathan, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Griffin, Benjamin R., The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
Background

Platelet decreases after continuous renal replacement therapy (CRRT) initiation are common and associated with increased mortality. Platelet activation during CRRT due to shear forces and membrane interactions may be associated with subsequent platelet loss. The degree of platelet activation can be approximated with mean platelet volume (MPV), as activated platelets undergo degranulation which increases their size. While MPV values at CRRT initiation correlate with mortality, MPV changes following CRRT initiation are unknown. We hypothesized that MPV would increase following CRRT initiation and correlate with mortality.

Methods

Adult patients admitted to the University of Iowa between January 1, 2019 and December 31, 2020, were included in this retrospective analysis. Patients were excluded if they survived <48 hours while on CRRT, or if fewer than two values were available for MPV. MPV was collected at the time of CRRT initiation and at 24, 48, and 72 hours. The primary outcome evaluated was in-hospital mortality. The final regression models were adjusted for age, sex, race, illness severity, and days of CRRT therapy.

Results

A total of 190 patients (81 survivors and 109 non-survivors) were included. MPV was significantly higher at each timepoint (24, 48, and 72 hours) in the full cohort compared to CRRT initiation, and increased by a greater amount over time in non-survivors than survivors. MPV at 72 hours was independently associated with in-hospital mortality after adjustments for covariates (OR 1.76, CI 1.15-2.69, p=.01).

Conclusion

MPV increased after CRRT initiation, especially in non-survivors, and MPV at 72 hours was independently associated with in-hospital mortality. These findings suggest that platelet activation temporally related to CRRT initiation may play a role in platelet loss and mortality in this population. Future studies will evaluate more direct measures of platelet activation in patients on CRRT and the impact of platelet activation blocking agents in this population.