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Platelet dysfunction and end-stage renal disease.

Dinkar Kaw1, Deepak Malhotra

  • 1Division of Nephrology, Department of Medicine, Medical University of Ohio, Toledo, Ohio, USA. dkaw@meduohio.edu

Seminars in Dialysis
|August 9, 2006
PubMed
Summary
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Patients with end-stage renal disease (ESRD) experience bleeding disorders due to platelet dysfunction. Hemodialysis can worsen bleeding and thrombosis, but treatments like desmopressin acetate may help.

Area of Science:

  • Nephrology
  • Hematology

Background:

  • End-stage renal disease (ESRD) is associated with significant hemostatic disorders, primarily bleeding diatheses.
  • Hemorrhage can manifest at various sites, including cutaneous, mucosal, serosal, retroperitoneal, and intracranial locations.

Purpose of the Study:

  • To summarize the causes of impaired hemostasis in ESRD patients.
  • To discuss the role of platelet dysfunction and hemodialysis in bleeding tendencies.
  • To outline potential treatment modalities for uremic bleeding.

Main Methods:

  • Review of existing literature on hemostasis in ESRD.
  • Analysis of factors contributing to platelet dysfunction in renal failure.
  • Examination of the impact of hemodialysis on hemostasis and thrombosis.

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Main Results:

  • Platelet dysfunction, stemming from intrinsic abnormalities and impaired vessel wall interaction, is the primary cause of bleeding in ESRD.
  • Anemia, accumulated medications, and anticoagulation during dialysis also contribute to impaired hemostasis.
  • Hemodialysis can partially correct defects but may also exacerbate bleeding and cause thrombosis due to artificial surface contact.

Conclusions:

  • Platelet dysfunction and impaired platelet-vessel wall interactions are central to bleeding diatheses in ESRD.
  • While dialysis may offer partial correction, it can also induce or worsen bleeding and thrombosis.
  • Therapeutic options such as desmopressin acetate, conjugated estrogen, and achieving a hematocrit of 30% can improve bleeding times in ESRD patients.