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Am J Kidney Dis. 2012 Jun;59(6):777-85. doi: 10.1053/j.ajkd.2011.12.027. Epub 2012 Mar 15.

Association of estimated GFR with platelet inhibition in patients treated with clopidogrel.

Author information

1
Hôpitaux universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.

Abstract

BACKGROUND:

The reasons that decreased glomerular filtration rate (GFR) might alter the clinical efficacy of clopidogrel are poorly understood.

STUDY DESIGN:

In this study, we sought to evaluate whether decreased GFR alters platelet response to clopidogrel in patients receiving a maintenance dose of clopidogrel (75 mg/d for at least 8 days).

SETTINGS & PARTICIPANTS:

126 consecutive patients categorized by estimated GFR: stages 1-2 (>60 mL/min/1.73 m(2); n = 29), stage 3a (45-59 mL/min/1.73 m(2); n = 21); stage 3b (30-44 mL/min/1.73 m(2); n = 26), stage 4 (15-29 mL/min/1.73 m(2); n = 14), and stage 5 (<15 mL/min/1.73 m(2); n = 36) were prospectively enrolled.

PREDICTOR:

Residual platelet reactivity, defined in the VASP (Vasodilator Stimulated Phosphoprotein) flow cytometry test as platelet reactivity index (PRI) ≥61% and in the VerifyNow turbidimetric-based assay as a value >235 PRU (adenosine diphosphate receptor reaction units) or percentage of platelet inhibition <15%.

OUTCOMES:

We examined factors associated with low response to clopidogrel using logistic regression.

RESULTS:

A significant relationship between estimated GFR, PRI, PRU, and percentage of inhibition was found. The prevalence of residual platelet reactivity was highest in patients with GFR stage 5. PRI ≥61% occurred in 52.8% of patients with stage 5 versus 30.8% of stage 3b and 24.1% of stages 1-2 (P = 0.1). PRU >235 was found in 63.6% of patients with stage 5 versus 36.8% of stage 3b and 17.2% of stages 1-2 (P = 0.005). Inhibition <15% affected 66.7% of patients with stage 5 versus 21.1% of stage 3b and 17.2% of stages 1-2 (P < 0.001). In the multivariable model, GFR stage 5 (adjusted prevalence ratio [PR], 3.10; 95% CI, 1.23-9.43; P = 0.02), and obesity (adjusted PR, 1.92; 95% CI, 1.34-2.23; P = 0.004) were the sole predictors of residual platelet reactivity.

LIMITATIONS:

Interference of hemodialysis with the pharmacokinetics of clopidogrel could not be excluded.

CONCLUSION:

GFR stage 5 is associated with substantial impairment of platelet inhibition independently of diabetes mellitus.

PMID:
22425260
DOI:
10.1053/j.ajkd.2011.12.027
[Indexed for MEDLINE]

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