Kidney and haemostasis. A (personal) time-journey

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Renal insufficiency leads to waste product accumulation, affecting platelet function and increasing bleeding risk.
• Drug accumulation due to impaired renal excretion necessitates dosage adjustments to prevent adverse events, including bleeding.
• Cardiovascular complications, especially non-valvular atrial fibrillation, significantly reduce survival in chronic kidney disease patients.

Purpose of the Study:

• To highlight the challenges of managing bleeding risks and anticoagulation in patients with renal insufficiency.
• To discuss the limitations of current anticoagulation strategies, such as vitamin K antagonists, in renal insufficiency.
• To explore the potential of new oral anticoagulants as safer and more effective alternatives.

Main Methods:

• Review of literature on renal insufficiency, drug metabolism, and anticoagulation.
• Analysis of KDIGO guidelines for evaluating kidney function (GFR).
• Discussion of clinical implications of drug accumulation and cardiovascular complications in renal patients.

Main Results:

• Renal insufficiency is associated with thrombocytopathy and increased bleeding risk from accumulated drugs.
• Vitamin K antagonists, while used for prophylaxis, are linked to increased bleeding and vascular calcification in renal patients.
• New oral anticoagulants show promise for improved efficacy and reduced bleeding compared to traditional agents.

Conclusions:

• New oral anticoagulants may be preferred for anticoagulation in renal insufficiency, including end-stage renal failure, given their efficacy and lower bleeding rates.
• Further research is required to establish optimal dosing, safety, and efficacy of new oral anticoagulants in diverse renal function.
• Serum FGF 23 concentration measurement could serve as a biomarker to guide the use of these novel anticoagulants.