Volume plaquettaire moyen et dysfonction de la fistule artério-veineuse dans une cohorte prospective de patients hémodialysés chroniques

Abstract : Introduction: Arteriovenous fistula (AVF) is the vascular access of 78% of haemodialysis patients in France. AVF dysfunctions such as thrombosis or stenosis are common complications. They are responsible for 30% of hospitalizations of chronic haemodialysis patients. One of the main factors behind these dysfunctions is an abnormality of hyperactive platelet-dependent coagulation during chronic renal failure. The more excitable young platelets are larger. Mean platelet volume (MPV) is a risk marker for major cardiovascular events. Objectives: Prospectively study MPV in our cohort of chronic haemodialysis as predictive marker of AVF dysfunction (occurrence of stenosis and acute thrombosis). We will study the mortality, the occurrence of cardiovascular events and serious haemorrhagic events. Materials and methods: The study included all chronic haemodialysis patients from the Conception Hospital at the CHU of Marseille between June 2014 and June 2016, component 226 patients. The main objective was to observe if there is a difference in the incidence of events on the AVF as dependent of the MPV. The population was divided according to 4 MPV levels determined by MPV quartiles in our cohort. The primary endpoint is a composite element called " AVF event" grouping: AVF acute thrombosis and AVF dysfunction requiring fistulography with endovascular treatment. Statistical analysis was done univarially by a Kaplan-Meier survival model and multivariate by a COX model Results: 193 patients were included in the study with a median follow-up of 620 days. The median VPM was 10.8 fl [7.8-13.5] and the following quartiles: group 1: VPM ≤ 10fl, group 2: 10.1fl ≤ VPM <10.7fl, group 3: 10.7fl ≤ VPM <11, 5fl, group 4: VPM ≥ 11.5 fl. There was no difference in the characteristics of these 4 groups. There was a higher incidence (p = 0.001) in group 4 with 23 events (59%), 14 (34%) in group 3, 11 (27%) in group 2 and 6 (18%) in group 1. The multivariate analysis shows an independent association between the MPV and the risk of occurrence of an event, the OR is 1.66 [1.24-2.23] p = 0.0007. There was no significant difference in mortality, occurrence of cardiovascular events or serious bleeding events. Conclusion: We have shown in our cohort of chronic haemodialysis that the risk of occurrence of an event on arteriovenous fistula (dysfunction requiring the realization of fistulography or acute thrombosis) is predicted by measuring the MPV. It thus makes it possible to identify the patients at risk of events on the AVF. This population could benefit from enhanced surveillance or anti-aggregating or anticoagulant therapies. Limiting the number of events on the AVF would reduce the occurrence of thrombosis or even loss of vascular access exposing the patient to a vital risk.
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Guillaume Lano. Volume plaquettaire moyen et dysfonction de la fistule artério-veineuse dans une cohorte prospective de patients hémodialysés chroniques. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01952607⟩



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