Immature platelet biomarkers in maintenance hemodialysis patients: baseline assessment and changes during a single hemodialysis session

Objective To assess the effect of a single HD session on immature platelet indices and mean platelet component (MPC) in maintenance HD patients. Methods Sixty-four clinically stable HD patients were studied before and after one hemodialysis session. Platelet count, immature platelet fraction (IPF), absolute immature platelet number (AIPN), MPC, and IL-6 were measured. Delta values were calculated as (post-HD − pre-HD)/pre-HD. Univariable correlations and multivariable linear regression models were used to explore the correlates of pre-dialysis IPF and dialysis-induced changes. Results Platelet count was unchanged after HD, whereas IPF and AIPN increased (2.1 ± 1.1 to 2.6 ± 1.5; p < 0.001 and 4.4 ± 2.7 to 5.4 ± 3.1×10^9/L; p < 0.001, respectively), MPC decreased (27.2 ± 1.0 to 26.6 ± 1.4 g/dL; p < 0.001), and IL-6 increased (4.45 [3.10–7.57] to 5.20 [3.03–8.88] pg/mL; p = 0.040). Pre-dialysis IPF directly correlated with age, dialysis vintage, IL-6, and inversely with albumin; the multivariable IPF model was significant overall. Delta-IPF correlated positively with heparin dose and inversely with age; in multivariable analysis, both variables remained independently associated with Delta-IPF. Conclusions A single HD session is associated with an acute increase in immature platelet indices and a reduction in MPC, indicating acute changes in surrogate biomarkers of platelet turnover and activation. The functional and prognostic significance of these findings requires confirmation using validated platelet-function assays and longitudinal clinical outcomes.