Effects of lipid-lowering treatment on platelet reactivity and platelet–leukocyte aggregation in diabetic patients without and with chronic kidney disease: a randomized trial
Nephrology Dialysis Transplantation,  Clinical Article

Almquist T et al. – Diabetes mellitus (DM) patients with chronic kidney disease (CKD) stages 3–4 had increased platelet–leukocyte aggregation (PLA) and inflammatory activity compared with DM patients with normal glomerular filtration rate. Simvastatin + ezetimbe decreased PLAs and plasma sCD40L in DM patients with concomitant CKD.

Methods
  • After a placebo run–in period, the effects of simvastatin alone (S) or simvastatin + ezetimibe (S + E) were compared in a randomized, double–blind, cross–over study on platelet reactivity.
  • PLA formation and inflammatory parameters.
  • Eighteen DM patients with estimated glomerular filtration rate (eGFR) 15–59 mL/min × 1.73 m2 (CKD stages 3–4) (DM–CKD) and 21 DM patients with eGFR >75 mL/min (DM–only) were included.

Results
  • PLAs were elevated at baseline in DM–CKD compared with DM–only (P = 0.04).
  • S + E reduced PLAs among total leukocytes and neutrophils in DM–CKD patients (P = 0.01 for both) but not in the DM–only group.
  • Platelet reactivity did not differ between patient groups or with LLT. Plasma levels of sCD40L (P < 0.001), elastase (P < 0.01) and von Willebrand factor (VWF) (P < 0.001) were elevated in DM–CKD compared with DM–only.
  • S + E reduced sCD40L in DM–CKD patients (P = 0.01), but LLT did not influence VWF or elastase.

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