Coexistence of Elevated Mean Platelet Volume and Bleeding Symptoms in Chronic Kidney Disease: A Discordant Hemostatic Profile

BACKGROUND: Hemostasis in chronic kidney disease (CKD) is currently becoming a complicated and disturbed process, not a simple bleeding disorder. Recent evidence suggests that the combination of elevated mean platelet volume (MPV) and bleeding, particularly during the initial phases of the disease, is a discordant hemostatic profile. OBJECTIVE: To examine the association between mean platelet volume (MPV) and bleeding symptoms among patients with chronic kidney disease (CKD) and to evaluate the utility of platelet indices in characterizing a discordant hemostatic profile. METHODS: This analytical cross-sectional study recruited 527 patients with CKD from tertiary care centers. Bleeding was measured on a questionnaire that included typical bleeding symptoms and a bleeding score. Platelet indices, such as mean platelet volume (MPV), platelet distribution width (PDW), and platelet count, were provided in the medical records. Data were evaluated using nonparametric tests, logistic regression, and receiver operating characteristic (ROC) curves. RESULTS: Bleeding symptoms were observed in 298 patients (56.5%). Bleeding participants had increased MPV, which increased with increasing CKD stages. Multivariate analysis showed MPV was significantly associated with bleeding symptoms (OR = 2.88, p < 0.001). ROC curves indicated moderate discriminative ability (area under the curve (AUC) = 0.730), but poor performance of PDW and non-predictive value of platelet count. CONCLUSION: CKD is associated with a discordant hemostatic profile of elevated MPV alongside bleeding symptoms. MPV may serve as a potential marker associated with bleeding symptoms in patients with CKD.