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Haemostasis in chronic kidney disease
Jens Lutz1, Julia Menke, Daniel Sollinger
1Schwerpunkt Nephrologie, I. Medizinische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Mainz, Germany.
Summary
Patients with renal failure experience altered coagulation, leading to bleeding or thrombosis risks. New factors like microparticles (MPs) and microRNAs significantly impact this complex pathophysiology.
Area of Science:
- Nephrology
- Hematology
- Cardiovascular Medicine
Background:
- Anticoagulant therapy is increasingly used in patients with renal failure due to cardiovascular comorbidities.
- Renal failure itself profoundly alters the coagulation system, independent of anticoagulant drugs.
- Coagulation disorders in renal failure contribute significantly to patient morbidity and mortality.
Purpose of the Study:
- To review the complex pathophysiology of coagulation disorders in patients with renal insufficiency.
- To highlight the role of novel factors, including microparticles and microRNAs, in these disorders.
Main Methods:
- Review of current literature on coagulation in renal failure.
- Analysis of the interplay between the coagulation cascade, platelets, and vessel wall in renal insufficiency.
- Investigation of the impact of microparticles (MPs) and microRNAs on coagulation.
Main Results:
- Patients with renal failure exhibit altered coagulation, increasing risks of bleeding and thrombosis.
- New anticoagulants may cause excessive bleeding due to pharmacokinetic changes in renal impairment.
- Microparticles (MPs) possess procoagulatory effects and can contain microRNAs that inhibit platelet function, contributing to bleeding.
Conclusions:
- Coagulation disorders in renal failure are multifactorial, involving intrinsic changes and external factors.
- Microparticles and microRNAs represent critical novel players in the pathophysiology of renal insufficiency-associated coagulopathy.
- Understanding these complex interactions is crucial for managing bleeding and thrombotic risks in patients with kidney disease.
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