Thrombocytopenia predicts mortality in Chinese hemodialysis patients- an analysis of the China DOPPS

Abstract

Background Hemodialysis (HD) patients have a higher mortality rate compared with general population. Our previous study revealed that platelet counts might be a potential risk factor. The role of platelets in HD patients has rarely been studied. The aim of this study is to examine if there is an association of thrombocytopenia (TP) with elevated risk of all-cause mortality and cardiovascular (CV) death in Chinese HD patients. Methods Data from a prospective cohort study, China Dialysis Outcomes and Practice Patterns Study (DOPPS) 5, were analyzed. Demographic data, comorbidities, platelet counts and other lab data, and death records which extracted from the medical record were analyzed. TP was defined as the platelet count below the lower normal limit (< 100*109/L). Associations between platelet counts and all-cause and CV mortality were evaluated using Cox regression models. Stepwise multivariate logistic regression was used to identify the independent associated factors, and subgroup analyses were also carried out. Results Of 1369 patients, 11.2% (154) had TP at enrollment. The all-cause mortality rates were 26.0% vs. 13.3% (p < 0.001) in patients with and without TP. TP was associated with higher all-cause mortality after adjusted for covariates (HR:1.73,95%CI:1.11,2.71), but was not associated with CV death after fully adjusted (HR:1.71,95%CI:0.88,3.33). Multivariate logistic regression showed that urine output < 200 ml/day, cerebrovascular disease, hepatitis (B or C), and white blood cells were independent impact factors (P < 0.05). Subgroup analysis found that the effect of TP on all-cause mortality was more prominent in patients with diabetes or hypertension, who on dialysis thrice a week, with lower ALB (< 4 g/dl) or higher hemoglobin, and patients without congestive heart failure, cerebrovascular disease, or hepatitis (P < 0.05). Conclusion In Chinese HD patients, TP is associated with higher risk of all-cause mortality, but not cardiovascular mortality. Platelet counts may be a useful prognostic marker for clinical outcomes among HD patients, though additional study is needed.

Plasma C4 level was associated with mortality, cardiovascular and cerebrovascular complications in hemodialysis patients

“…For further exploration, we then performed multivariate Cox regression analyses to control confounding variables (Table 3 ). Model I was constructed to adjust for age and PLT because of their low p values and clinical importance reported before [ 31 ]. Furthermore, there was no collinearity among the independent variables as their VIF < 10 and tolerance > 0.1 (Table S 3 ).…”

“…Apart from the well-known conjunction in complement pathways, C4 may have distinct effects on metabolism and chronic inflammation [ 38 ]. Studies of human populations have shown that C3 and C4 are associated with the incidence of myocardial infarction and stroke [ 22 ], as well as with their risk factors, such as obesity, hypertension, hyperlipemia and diabetes [ 28 – 31 ]. Analogous associations were sighted in our HD cohort between plasma C4 and the incidence of CCEs and hyperlipemia.…”

“…Survival analyses were performed by using the univariate and multivariate Cox regression for three endpoints respectively. Considering the event number [ 30 ], two confounders (with the lowest p value and reported important [ 31 ]) were applied to adjust in the multivariate Cox regression. We calculated the variance inflation factor (VIF) values and tolerance to evaluate collinearity between variables, with VIF > 10 and tolerance < 0.1 considered indicative of collinearity.…”

Low‐density lipoprotein cholesterol, erythrocyte, and platelet in heart failure with preserved ejection fraction

“…10,11 Low platelet count has been associated with risk of all-cause death and HF readmission in patients with acute HF and haemodialysis patients. 12,13 Further, low LDL-C reflects impaired immune function and cardiac cachexia. 14,15 Low erythrocytes have been associated with renal dysfunction, and low platelets have been related to impaired haemostasis function and liver dysfunction.…”

Application of Angiotensin Receptor–Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus

“…In patients undergoing hemodialysis and peritoneal dialysis, the prevalence of cardiovascular diseases is as high as 76.5 and 65%, respectively ( 6 ). In China, over 50% of dialysis patients die of cardiovascular and cerebrovascular events ( 7 ).…”