Assessment of Frailty in patients with Advanced Chronic Kidney Disease and the role of Circulating Microvesicles

Abstract

Abstract Frailty is a highly prevalent syndrome inpatients with advanced age and chronic diseases, and it is associated with atherothrombotic pathologies, suggesting a procoagulant state in these patients. Circulating microvesicles (cMVs), are small phospholipid-rich vesicles, which have been shown to participate in atherothrombotic onset and progression. We aim to analyze frailty in patients with advanced chronic kidney disease (CKD), and to determine the role of microvesicles in this population. We conducted a prospective cohort study with 85 patients with advanced CKD. Fried's five criteria were used to define frailty. We obtained blood for cMVs analysis by flow cytometry. There was a follow-up time of 27 months during which dialysis initiation and mortality was assessed. The prevalence of frailty in patients with advanced CKD was 27%. We found that risk factors for frailty were age, type 2 diabetes mellitus and anemia. Total cMVs, platelet derived cMVs and endothelial derived cMVs were significantly higher in frail patients. CD142 (platelet tissue factor), a procoagulant marker, was also significantly higher in frail patients. Although we still do not know in depth the mechanisms involved in frailty, to our knowledge this is the first study that links cMVs and frailty in patients with advanced CKD, suggesting this could be a good biomarker or therapeutic target in advanced CKD.