Diabetes mellitus (DM), which affects millions of people and places a heavy burden on healthcare systems around the world, continues to be a global health concern. Diabetic nephropathy (DN) is a prominent cause of end-stage renal disease (ESRD), contributing significantly to morbidity and mortality among its many consequences [1]. DN is characterized by progressive renal damage, marked by albuminuria, declining glomerular filtration rate (GFR), and eventual renal failure, driven by chronic hyperglycemia, hypertension, and a cascade of inflammatory and thrombotic processes [2]. While the pathophysiology of DN is multifaceted, emerging evidence suggests that hematological parameters, such as mean platelet volume (MPV), may serve as novel biomarkers for assessing disease progression and cardiovascular risk in affected patients [3].

Diabetic nephropathy affects approximately 20–40% of patients with type 1 and type 2 diabetes, making it the most common etiology of chronic kidney disease (CKD) globally [1]. The condition begins insidiously with microalbuminuria, progressing to overt proteinuria and, ultimately, ESRD if left unchecked. Hyperglycemia-induced endothelial dysfunction, oxidative stress, and activation of the renin-angiotensin-aldosterone system (RAAS) are well-established drivers of renal injury in DN [2]. However, recent research has shifted focus toward the role of inflammation and hemostatic abnormalities, which appear to exacerbate renal damage and contribute to the high cardiovascular mortality observed in these patients [4]. Platelets, traditionally recognized for their role in thrombosis, are increasingly implicated in the inflammatory milieu of DN, with MPV emerging as a simple yet promising indicator of platelet activity and dysfunction [3].

Mean platelet volume, a measure of the average size of circulating platelets, is routinely reported as part of a complete blood count (CBC) and reflects platelet production and activation status [5]. Normal MPV values typically range from 7.5 to 11.5 femtoliters (fL), though this can vary slightly depending on laboratory standards. Larger platelets, indicated by elevated MPV, are metabolically more active, contain denser granules, and exhibit greater prothrombotic potential than smaller platelets[5]. Conversely, lower MPV may suggest bone marrow suppression or increased platelet consumption. The accessibility of MPV as a cost-effective, non-invasive parameter has fueled interest in its utility across various disease states, including cardiovascular disease, diabetes, and CKD[6].

Source of Data The study utilized data from patients with diabetes mellitus who presented to the Outpatient Department (OPD) and Casualty of Vijayanagara Institute of Medical Sciences (VIMS), Ballari, during the study period. The hospital served as the primary site for patient recruitment and data collection, leveraging its established infrastructure and patient population. Study Design A hospital-based cross-sectional study design was employed. This approach allowed for the assessment of MPV and its association with DN at a single point in time among patients attending VIMS Ballari. Inclusion Criteria • Patients were selected based on strict inclusion criteria to ensure relevance to the study objectives. The following criteria were applied: • Patients diagnosed with diabetic nephropathy, defined as individuals with type-2 diabetes mellitus exhibiting microalbuminuria. • Patients who provided informed consent to participate in the study. Exclusion Criteria To minimize confounding variables and ensure the validity of the findings, the following exclusion criteria were enforced: • Patients with gestational diabetes mellitus. • Male patients with hemoglobin (Hb) levels below 12 g% and female patients with Hb levels below 11 g%. • Patients receiving antiplatelet or antithrombotic medications. • Patients with a diagnosed malignancy. • Patients with urinary tract infections (UTI) or cardiac failure. Method of Data Collection Data were collected from patients who satisfied the inclusion criteria and provided written consent at VIMS Ballari. No specific sampling procedure beyond eligibility screening was utilized; consecutive patients meeting the criteria during the study period were enrolled. Clinical data, including demographic details, medical history, laboratory results (e.g., MPV, hemoglobin, microalbuminuria), and relevant comorbidities, were recorded using a standardized proforma. Blood samples were obtained under aseptic conditions as part of routine diagnostic workup, and MPV was measured using an automated hematology analyzer available at the hospital laboratory.

The study included 59 patients. The mean MPV was 11.1 ± 1.2 fL. MPV correlated positively with microalbuminuria levels and was higher in patients with complications like stroke and myocardial infarction. Summary of Study Results: Mean Platelet Volume in Diabetic Nephropathy This is  summary of the results section from the study conducted by Dr. Ramu on the association of Mean Platelet Volume (MPV) in patients with Diabetic Nephropathy (DN). The study evaluated 59 patients with Type 2 Diabetes Mellitus and microalbuminuria. The aim was to assess whether elevated MPV levels correlate with the severity of nephropathy and associated thrombotic risks.Table: Summary of Clinical Parameters (n = 59)

Table 1: Age Distribution (Mean ± SD and Categorical)

Table 1 presents the age distribution of the study cohort. The mean age of participants is 61.7 years with a standard deviation of 8.4 years, indicating a middle-aged to elderly population. The age distribution shows that 11 participants (18.6%) are between 40-49 years, 17 participants (28.8%) are between 50-59 years, 19 participants (32.2%) are between 60-69 years, and 12 participants (20.3%) are 70 years or older. The 60-69 age group has the highest representation, comprising nearly one-third of the total sample of 59 participants. There is a relatively balanced distribution across age categories, though a slight predominance in the 60-69 year range indicates this may be the typical age range for presentation or diagnosis of the condition being studied.

Table 2: Sex Distribution

Table 2 illustrates the gender distribution of the study population. Males constitute 38 participants (64.4%) while females represent 21 participants (35.6%) of the total 59 participants. This shows a notable male predominance with nearly two-thirds of the study population being male. This gender imbalance may reflect the epidemiology of the underlying condition or could represent a selection bias in the study recruitment process. The male preponderance might affect the generalizability of findings to the broader population, particularly for females with the condition under investigation.

Table 3: Baseline Clinical Characteristics (Categorical Variables)

Table 3 presents the prevalence of comorbidities in the study population. Hypertension is present in 41 participants (69.5%), indicating that more than two-thirds of the study population have elevated blood pressure requiring treatment or monitoring. Dyslipidemia is present in 28 participants (47.5%), affecting nearly half of the study cohort. These findings highlight the high prevalence of cardiovascular risk factors in this population, which is consistent with the metabolic profile typically associated with type 2 diabetes and diabetic nephropathy. The high prevalence of these comorbidities suggests that most patients in this cohort have multiple cardiometabolic risk factors that may contribute to their overall thrombotic risk.

Table 4: Prevalence of Thrombotic Events

Table 5: MPV and Thrombotic Events (Primary and Secondary Outcomes)

Table 6: MPV Correlation with Renal Function Parameters

Table 6 presents correlations between MPV and renal function parameters. MPV shows a moderate positive correlation with microalbuminuria (r=0.36) that is statistically significant (p=0.005), indicating that higher MPV is associated with greater urinary albumin excretion. Similarly, MPV demonstrates a moderate positive correlation with serum creatinine (r=0.41) that is highly significant (p=0.001), suggesting that higher MPV is associated with worse renal function as indicated by elevated creatinine levels. Conversely, MPV shows a moderate negative correlation with estimated glomerular filtration rate (eGFR) (r=-0.43) that is also highly significant (p=0.001), confirming that higher MPV is associated with reduced kidney function. These consistent and statistically significant correlations across all three renal parameters strongly suggest that MPV has a meaningful relationship with kidney function, potentially serving as a marker of renal impairment severity or sharing common pathophysiological mechanisms with diabetic nephropathy.

This study investigated the relationship between mean platelet volume (MPV) and thrombotic events in patients with diabetic nephropathy (DN) and evaluated its association with renal function, glycemic control, and cardiovascular risk factors. The findings demonstrated that patients with thrombotic complications, particularly stroke and myocardial infarction, had significantly higher MPV values than those without such events, suggesting that elevated MPV reflects increased platelet activation and a greater thrombotic risk. These findings are consistent with previous studies indicating that larger platelets are more metabolically active and possess greater prothrombotic potential. Although thromboembolism also showed a trend toward higher MPV, the association was not statistically significant, likely because of the limited sample size. The study further demonstrated significant correlations between MPV and renal function parameters. MPV showed positive correlations with microalbuminuria and serum creatinine, while exhibiting a negative correlation with estimated glomerular filtration rate (eGFR), indicating that increasing MPV is associated with worsening renal function. These observations support the hypothesis that declining kidney function, chronic inflammation, oxidative stress, and the accumulation of uremic toxins contribute to increased platelet size and activation. Thus, elevated MPV may serve as an indicator of progressive renal impairment in patients with diabetic nephropathy. Among glycemic parameters, HbA1c showed the strongest positive correlation with MPV, whereas fasting blood sugar and postprandial blood sugar demonstrated weaker, non-significant associations. This suggests that chronic hyperglycemia has a greater influence on platelet activation than short-term glucose fluctuations. Persistent hyperglycemia promotes glycation of platelet membrane proteins, oxidative stress, and inflammatory changes that enhance platelet reactivity. Consequently, effective glycemic control may reduce MPV and improve cardiovascular outcomes, making MPV a potential marker for monitoring treatment response in diabetic patients. Regarding cardiovascular risk factors, systolic blood pressure was significantly associated with MPV, while diastolic blood pressure, body mass index, and platelet count showed no significant correlations. The positive association between systolic hypertension and MPV may reflect increased vascular shear stress, endothelial dysfunction, and activation of the renin–angiotensin–aldosterone system, all of which contribute to platelet activation. Although hypertension and dyslipidemia showed higher rates of thrombotic events, these associations did not reach statistical significance, probably because of the relatively small sample size and ongoing treatment of these comorbidities. The study also observed a gradual increase in MPV with advancing age, although this trend was not statistically significant. Older patients may have higher MPV because of prolonged exposure to diabetes, chronic inflammation, oxidative stress, and age-related changes in platelet production. These findings suggest that advancing age and longer disease duration may further contribute to platelet activation and vascular complications in diabetic nephropathy. Overall, the findings support the use of MPV as a simple, inexpensive, and routinely available biomarker for risk stratification in diabetic nephropathy. Since MPV is included in routine complete blood counts, it can be easily incorporated into clinical practice to identify patients at higher risk for thrombotic events and disease progression. Combining MPV with other inflammatory and hematological biomarkers may further improve risk prediction and prognostic accuracy. The study also highlights important therapeutic implications. Improving glycemic control, optimizing blood pressure management, and using medications such as metformin, SGLT2 inhibitors, GLP-1 receptor agonists, RAAS inhibitors, and statins may reduce MPV and platelet activation, thereby decreasing cardiovascular risk. However, antiplatelet therapy should be individualized because its benefits must be balanced against the potential risk of bleeding. Despite these promising findings, several limitations should be acknowledged. The cross-sectional design does not establish causality, the sample size was relatively small, and platelet activation markers were not directly measured. In addition, pre-analytical factors affecting MPV measurement were not standardized, and the results are applicable primarily to patients with established diabetic nephropathy. Therefore, larger prospective studies with standardized MPV measurement protocols are required to validate these findings and determine whether reducing MPV translates into improved clinical outcomes. In conclusion, this study demonstrates that elevated MPV is significantly associated with thrombotic events, impaired renal function, poor glycemic control, and increased cardiovascular risk in patients with diabetic nephropathy. These findings suggest that MPV has considerable potential as a complementary biomarker for identifying high-risk patients, guiding risk stratification, monitoring treatment response, and supporting comprehensive management strategies aimed at reducing both renal and cardiovascular complications.

Elevated MPV is significantly associated with diabetic nephropathy and its complications. Routine MPV monitoring in diabetic patients may provide an early indicator of nephropathy progression and cardiovascular risk. Further large-scale prospective studies are needed to validate MPV as a clinical tool in DN management.

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