[Haemocoagulation and renal insufficiency, haemocoagulation and type 2 diabetes mellitus]

Diabetes mellitus is a frequent cause of renal insufficiency. Renal insufficiency is associated with both haemorrhagic manifestations primarily caused by platelet functional disorders, and states of hypercoagulation resulting from significant hyperfibrinogenemia. Fibrinolysis is either increased or, often, decreased. Changes in haemostasis in renal insufficiency have been dealt with by many authors in relevant literature. However, the final stage of renal insufficiency is rather dominated by haemorrhagic diathesis. It is manifested by skin haemorrhage, mucosal manifestations, but also by retroperitoneal and cerebral haemorrhage. The main cause of a haemorrhagic condition is platelet dysfunction combined with anticoagulation and antiplatelet therapy which is used in dialysis. Platelet function disorders are provoked by acquired thrombocytopaenia and result in a disorder in the interaction between the blood vessel wall and the platelet. Dialysis suppresses platelet abnormalities only temporarily by suppressing uremic toxins provoking platelet disorders. On the other hand, dialysis may cause prothrombotic activity. Changes in haemostasis in type 2 diabetes mellitus form part of the insulin resistance syndrome and induce prothrombotic condition due to decreased fibrinolysis.