Cardiovascular diseases are the main cause of mortality in end stage renal disease (ESRD) and arterial stiffness is major determinant of mortality. Platelet aggregation contributes to thrombosis. We tested it in ESRD according to aortic pulse wave velocity (PWV, measure of aortic stiffness) and augmentation index (AI, index of central wave reflections).

Methods: 50 ESRD were explored with aortic PWV (Complior Analyse ^®), and central blood pressure measurement (Sphygmocor^®) plus platelet aggregation (AG) at 3 and 6 minutes and surface under the curve at 4 minutes (SD Innovation^®), with collagen 2 and 20 μg/mL, and ADP 5 and 10 μM, just before one hemodialysis. Analysis included ANOVA, ANCOVA adjusted on age, gender, SBP, diabetes, treatments (hypertension, lipids), and multiple robust regression (NCSS^®).

Results: 24 patients received anti-platelet treatment: age=72±3 years, men/women=17/7, SBP/DBP=143±4/73±2 mmHg, PWV=12.1±0.7 m/s, AI%=41±2%, vs 26 patients without anti-platelet drugs: respectively 69±3 years, m/w=7/19, 141±5/75±2 mmHg, 11.3 ±0.4 m/s, 42±2 % (all comparisons: NS).

Aggregation with the low concentration of ADP was positively correlated with PWV for the whole population as for both groups.

Aggregation with the high concentration of collagen (independent of the thromboxane pathway) was correlated with AI for all. Different parameters of the aggregation curves with the low concentration of ADP or collagen were correlated with AI for each group.

Conclusion: PWV and AI were associated with platelet aggregation characteristics in ESRD independently of anti-platelet drugs. Interface vascular wall-platelet, at the level of macrocirculation and microcirculation, may impact the cardiovascular risk of mortality in ESRD.