Thrombocytopenia in patients receiving maintenance hemodialysis by the hemodiafiltration method

The aim of this study was to assess the frequency of thrombocytopenia and its clinical significance – including bleeding episodes and the feasibility of prescribing antithrombotic therapy when indicated – in patients receiving post-dilution hemodiafiltration (HDF).

Materials and methods. In this 13-month prospective study, 193 patients (55.4% male) who had been receiving post-dilution HDF for at least 6 months were enrolled. The minimum follow-up duration was 6 months, and the maximum was 13 months. Patients were divided into groups: those without thrombocytopenia (n=102) and those with persistent thrombocytopenia (n=45), defined as platelet count reduction in more than 50% of monthly measurements; these groups formed the basis of the primary analysis. Additionally isolated episodes of thrombocytopenia (<50% of observations), the relationship between mean platelet count and clinical-laboratory parameters, antithrombotic therapy, and the frequency of hemorrhagic complications were evaluated.

Results. Thrombocytopenia occurred in 47.2% patients (at least one episode) and was persistant in 23.3%. Most cases were mild (80%) or moderate (13.3%); severe thrombocytopenia was rare (1.6%). Antithrombotic therapy was prescribed in 29.5% of patients. Minor bleeding events occurred in 3% of patients; most of whom were receiving antithrombotic therapy and had thrombocytopenia at the time of the episode. No significant differences were observed in the frequency of antithrombotic therapy prescription between the patients with and without persistent thrombocytopenia, or between those with mild versus moderate thrombocytopenia (p>0.05). Mean platelet count was not associated with the type or dose of anticoagulant used during HDF (p>0.05). Significant associations (p<0.05) were identified between platelet counts and several hematological, iron-status, nutritional, inflammatory (C-reactive protein), and HDF-related parameters (effective infusion volume and mean filtration fraction).

Conclusion. Thrombocytopenia is common in HDF patients (23.3-47.2%) but is typically mild to moderate in severity. Antithrombotic therapy administered outside HDF sessions did not influence the development or severity of thrombocytopenia. In this study, persistent mild-to-moderate thrombocytopenia had no significant clinical impact on bleeding risk and likely should not preclude the prescription of indicated antithrombotic therapy. Nonetheless, when initiating such therapy to dialysis patients, clinicians should carefully balance its benefits against potential risks, including bleeding, particularly in those with thrombocytopenia. The observed associations variants warrant further investigation.

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