TY - JOUR
T1 - Platelet Abnormalities in CKD and Their Implications for Antiplatelet Therapy
AU - Baaten, C.C.F.M.J.
AU - Schroer, J.R.
AU - Floege, J.
AU - Marx, N.
AU - Jankowski, J.
AU - Berger, M.
AU - Noels, H.
N1 - Funding Information:
This work was supported by the Alexander von Humboldt Foundation (to C. Baaten), the Dutch Heart Foundation (2020T020, to C. Baaten), the START-Program of the Faculty of Medicine of the RWTH Aachen University (105/20 to C. Baaten and H. Noels), and by the German Research Foundation Project-ID 322900939, SFB/TRR219 (S-03, C-01, C-04, M-03, M-05 to J. Jankowski, H. Noels, J. Floege, and N.Marx) and Project-ID 403224013- SFB 1382 (A-04 to J. Jankowski and H. Noels). Further funding was provided by the CORONA foundation (to J. Jankowski and N. Marx) and the Else Kröner-Fresenius-Stiftung (Project 2020_EKEA.60 to H.Noels).
Publisher Copyright:
© 2022 by the American Society of Nephrology.
PY - 2022/1
Y1 - 2022/1
N2 - Patients with CKD display a significantly higher risk of cardiovascular and thromboembolic complications, with around half of patients with advanced CKD ultimately dying of cardiovascular disease. Paradoxically, these patients also have a higher risk of hemorrhages, greatly complicating patient therapy. Platelets are central to hemostasis, and altered platelet function resulting in either platelet hyper- or hyporeactivity may contribute to thrombotic or hemorrhagic complications. Different molecular changes have been identified that may underlie altered platelet activity and hemostasis in CKD. In this study, we summarize the knowledge on CKD-induced aberrations in hemostasis, with a special focus on platelet abnormalities. We also discuss how prominent alterations in vascular integrity, coagulation, and red blood cell count in CKD may contribute to altered hemostasis in these patients who are high risk. Furthermore, with patients with CKD commonly receiving antiplatelet therapy to prevent secondary atherothrombotic complications, we discuss antiplatelet treatment strategies and their risk versus benefit in terms of thrombosis prevention, bleeding, and clinical outcome depending on CKD stage. This reveals a careful consideration of benefits versus risks of antiplatelet therapy in patients with CKD, balancing thrombotic versus bleeding risk. Nonetheless, despite antiplatelet therapy, patients with CKD remain at high cardiovascular risk. Thus, deep insights into altered platelet activity in CKD and underlying mechanisms are important for the optimization and development of current and novel antiplatelet treatment strategies, specifically tailored to these patients who are high risk. Ultimately, this review underlines the importance of a closer investigation of altered platelet function, hemostasis, and antiplatelet therapy in patients with CKD.
AB - Patients with CKD display a significantly higher risk of cardiovascular and thromboembolic complications, with around half of patients with advanced CKD ultimately dying of cardiovascular disease. Paradoxically, these patients also have a higher risk of hemorrhages, greatly complicating patient therapy. Platelets are central to hemostasis, and altered platelet function resulting in either platelet hyper- or hyporeactivity may contribute to thrombotic or hemorrhagic complications. Different molecular changes have been identified that may underlie altered platelet activity and hemostasis in CKD. In this study, we summarize the knowledge on CKD-induced aberrations in hemostasis, with a special focus on platelet abnormalities. We also discuss how prominent alterations in vascular integrity, coagulation, and red blood cell count in CKD may contribute to altered hemostasis in these patients who are high risk. Furthermore, with patients with CKD commonly receiving antiplatelet therapy to prevent secondary atherothrombotic complications, we discuss antiplatelet treatment strategies and their risk versus benefit in terms of thrombosis prevention, bleeding, and clinical outcome depending on CKD stage. This reveals a careful consideration of benefits versus risks of antiplatelet therapy in patients with CKD, balancing thrombotic versus bleeding risk. Nonetheless, despite antiplatelet therapy, patients with CKD remain at high cardiovascular risk. Thus, deep insights into altered platelet activity in CKD and underlying mechanisms are important for the optimization and development of current and novel antiplatelet treatment strategies, specifically tailored to these patients who are high risk. Ultimately, this review underlines the importance of a closer investigation of altered platelet function, hemostasis, and antiplatelet therapy in patients with CKD.
KW - chronic kidney disease
KW - thrombosis
KW - platelets
KW - platelet aggregation inhibitors
KW - blood platelet disorders
KW - CHRONIC KIDNEY-DISEASE
KW - ACUTE CORONARY SYNDROME
KW - FIBRIN CLOT PROPERTIES
KW - RENAL-FUNCTION
KW - LONG-TERM
KW - CARDIOVASCULAR-DISEASE
KW - RETICULATED PLATELETS
KW - ADENOSINE-DIPHOSPHATE
KW - HEMODIALYSIS-PATIENTS
KW - THROMBUS FORMATION
U2 - 10.2215/CJN.04100321
DO - 10.2215/CJN.04100321
M3 - (Systematic) Review article
C2 - 34750169
SN - 1555-9041
VL - 17
SP - 155
EP - 170
JO - Clinical journal of the American Society of Nephrology
JF - Clinical journal of the American Society of Nephrology
IS - 1
ER -