title: Combined and independent impact of diabetes mellitus and chronic kidney disease on residual platelet reactivity.
abstract: Patients with both chronic kidney disease (CKD) and diabetes mellitus (DM) are at increased risk for thrombotic events compared to those with one abnormality alone. Whether this can be attributed to changes in platelet reactivity among those with both CKD and DM is unknown. We prospectively studied 438 clopidogrel-naïve patients undergoing percutaneous coronary intervention (PCI). Platelet function tests were performed 4-6 hours after loading with 600 mg of clopidogrel. Platelet reactivity was assessed using the VerifyNow system and expressed as P2Y12 reaction units (PRU). High residual platelet reactivity (HRPR) was defined as PRU > 230. Patients were categorised into four groups by the presence or absence of CKD and DM. Among those without CKD or DM (n=166), DM alone (n=150), CKD alone (n=60) and both CKD and DM (n=62) the mean PRU levels were 201.6 ± 96.3, 220.5 ± 101.1, 254.9 ± 106.7 and 275.0 ± 94.5, respectively (p<0.001). Analogously, the prevalence of HRPR was 42.3%, 50.7%, 63.3% and 75.8%, respectively (p< 0.001). Associations between either CKD or DM alone and HRPR were attenuated after multivariable adjustment while the odds for HRPR associated with both CKD and DM remained significant (OR [95% CI]: 2.61 [1.16 - 5.86]). In conclusion, the presence of both CKD and DM confers a synergistic impact on residual platelet reactivity when compared to either condition alone. Whether more potent platelet inhibitors may improve outcomes among patients with both abnormalities warrants investigation.
authors.affiliation: Cardiac Catheterization Laboratory, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA. samin.sharma@mountsinai.org
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bander
authors.forename: Rucha
authors.initials: R
authors.lastname: Karajgikar
authors.forename: Kapil
authors.initials: K
authors.lastname: Yadav
authors.forename: Ali
authors.initials: A
authors.lastname: Hadi
authors.forename: Kleanthis
authors.initials: K
authors.lastname: Theodoropolous
authors.forename: Nilusha
authors.initials: N
authors.lastname: Gukathasan
authors.forename: Swathi
authors.initials: S
authors.lastname: Roy
authors.forename: Swapna
authors.initials: S
authors.lastname: Sayeneni
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Scott
authors.forename: Jason C
authors.initials: JC
authors.lastname: Kovacic
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yu
authors.forename: Samantha
authors.initials: S
authors.lastname: Sartori
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Jaime
authors.initials: J
authors.lastname: Uribarri
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Badimon
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Pedro
authors.initials: P
authors.lastname: Moreno
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D048909:Diabetes Complications / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D015539:Platelet Activation; D010979:Platelet Function Tests; D011300:Preoperative Care; D011446:Prospective Studies; D058925:Receptors, Purinergic P2Y12 / Q000378:metabolism; D012306:Risk; D013927:Thrombosis; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: C548576:P2RY12 protein, human; D058925:Receptors, Purinergic P2Y12; D000077144:Clopidogrel; D013988:Ticlopidine