الفهرس 
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Abstract
In patients with DM , metabolic disorders disturb the physiological balance of coagulation and fibrinolysis, leading to a prothrombotic state characterized by platelet hypersensitivity, coagulation disorders and hypofibrinolysis, Hyperglycemia and insulin resistance cause changes in platelet number and activation, as well as qualitative and/or quantitative modifications of coagulation and fibrinolytic factors, resulting in the formation of fibrinolysis-resistant clots in patients with DM
DM is associated with increased complications due to variety of abnormalities reported in diabetic platelets, these diabetic platelets, in response to stimulating agents can exhibit increased adhesiveness and exaggerated aggregation phenomenon.
In CKD both bleeding and thrombotic complications are observed mainly because of disturbed balance between pro- and anti-hemostatic factors, leading to high morbidity and mortality
Various defects in primary hemostasis have been described in uremia. These include abnormalities in platelet number, dense granule content, concentration of intracellular ADP, serotonin and cyclic AMP, release of platelet α granules, calcium ion mobilization, arachidonic acid metabolism, cyclooxygenase activity, GP IIb IIIa binding, platelet aggregation and adhesion, vWF activity, prostaglandin I2 and nitric oxide production by the vessel wall, and altered blood rheology due to anemia.
Few studies from different parts of the world studied impact of DM on platelets function and coagulation system and they revealed that DM is a key factor for CV complications and mortality in CKD patients .
Thus, we did a cross sectional study in sohag university hospital on 150 patients classified into 3 groups , each one include 50 patients to evaluate the platelets indices and basic coagulation profile in patients having T2DM with CKD as compared to CKD patients without DM and diabetic patients without CKD and we found significant impact when CKD combined with diabetes mellitus on platelet indices, fibrinogen and basic coagulation profile that indicate higher risk of thrombotic events in those patients especially cardiovascular complications and higher incidence of morbidity and mortality .
Conclusion
Diabetic state and poor glycaemic control have a great impact on platelet indices and basic coagulation parameters in patients with CKD and shows significant increases in MPV and PDW and PCT , also there was significant shortening in APTT and significant increase in serum fibrinogen level in diabetic CKD patients.
So the assessment of platelet indices and basic coagulation parameters including serum fibrinogen is mandatory for all CKD patients with DM to assess the risk of thrombosis and can predict long term complications on cardiovascular system and detect the best preventive measures .
Recommendations
In patients with diabetes mellitus and chronic kidney disease it is advised to take care for the high possibility of cardiovascular complications especially if there is poor glycemic control as it affects platelets indices and basic coagulation profile leading to imbalance between thrombotic factors than anti-thrombotic factors so good control of diabetic state is advised and to measure platelet indices and basic coagulation profile and fibrinogen level as a simple, easily accessible and cheap way to evaluate those patients and to correct any abnormality in those parameters and consequently prevent cardiovascular complications on those patients.