Dysfunction of the Arteriovenous Fistula and Mean Platelet Volume (MPV): What Relationship?

Abstract

Dysfunctions of the AVF such as thrombosis or stenosis are frequent complications. One of the main factors at the origin of these dysfunctions is an anomaly of coagulation dependent on overactive platelets during chronic renal insufficiency. Younger, more excitable platelets are larger in size. Mean platelet volume (MPV) is a risk marker for major cardiovascular events. This is a retrospective analytical study including chronic hemodialysis patients for more than 6 months on AVF at the CHU Ibn Rochd hospital in Casablanca over a period of 5 years, from January 2018 to January 2023. The population was divided into 4 levels of MPV determined according to the quartiles of MPV in our cohort, group 1: MPV ≤ 10fl, group 2: 10.1fl ≤ MPV < 10.7fl, group 3: 10.7fl≤ MPV < 11.5fl, group 4: MPV ≥ 11.5fl. The four groups were compared with regard to the occurrence of AVF dysfunctions. Forty-four hemodialysis patients on AVF were collected, 20 men (45.5%) and 24 women (54.5%). a sex ratio F/M of 1.2. The average age of the patients was 45.25 ± 13.78 years [18 – 69] the average seniority in hemodialysis was 14.23 ± 8.807 years [2 – 34] AVF complications were noted in 38.6% of cases (n=17), including 27.2% thrombosis (n=12), 4.5% stenosis (n=2) and 2.27% had bleeding (n=1). The MPV was 10.61 fl ± 1.305 [8–14]. We noted a statistically significant difference in the occurrence of vascular access events according to the MPV quartile (p =0.005). Seven events (41.1%) were noted in group 4 (upper quartile), 6 (35.2%) in group 3, 3 (17.64%) in group 2 and 1 (5.88%) in group 1. We also found a statistically significant correlation for the recurrence of thrombosis according to the MPV quartile (p= 0.003). Indeed, in the 4th group, 1 patient had relapsed 6 times, 1 patient had thrombosed his AVF 4 times, 2 patients had thrombosed their AVF 3 times and 2 others had relapsed twice. A high MPV helps identify patients at risk for AVF events. This at-risk population could thus benefit from reinforced and close monitoring, or even antiaggregation or anticoagulant therapy.