Platelet Abnormalities in CKD and Their Implications for Antiplatelet Therapy

C.C.F.M.J. Baaten, J.R. Schroer, J. Floege, N. Marx, J. Jankowski, M. Berger*, H. Noels*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

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.
Original languageEnglish
Pages (from-to)155-170
Number of pages16
JournalClinical journal of the American Society of Nephrology
Volume17
Issue number1
Early online date23 Nov 2021
DOIs
Publication statusPublished - Jan 2022

Keywords

  • chronic kidney disease
  • thrombosis
  • platelets
  • platelet aggregation inhibitors
  • blood platelet disorders
  • CHRONIC KIDNEY-DISEASE
  • ACUTE CORONARY SYNDROME
  • FIBRIN CLOT PROPERTIES
  • RENAL-FUNCTION
  • LONG-TERM
  • CARDIOVASCULAR-DISEASE
  • RETICULATED PLATELETS
  • ADENOSINE-DIPHOSPHATE
  • HEMODIALYSIS-PATIENTS
  • THROMBUS FORMATION

Fingerprint

Dive into the research topics of 'Platelet Abnormalities in CKD and Their Implications for Antiplatelet Therapy'. Together they form a unique fingerprint.

Cite this