Navigating through the haemostatic paradox in kidney failure: A practical overview

Area of Science:

• Nephrology
• Hematology
• Internal Medicine

Background:

• Chronic kidney disease (CKD) affects 9.1% globally, posing a significant health burden.
• Patients with CKD, especially those on dialysis, have a dual risk of bleeding and thrombosis.
• Limited clinical evidence exists for managing hemostatic challenges in this vulnerable population.

Purpose of the Study:

• To review the current understanding of hemostasis in end-stage kidney disease (ESKD).
• To translate basic science knowledge into clinical practice for managing bleeding and thrombosis in CKD patients.
• To provide evidence-based guidance for optimal patient management.

Main Methods:

• Literature review of basic science principles of hemostasis in ESKD.
• Analysis of clinical challenges in managing bleeding and thrombosis in CKD patients.
• Synthesis of existing evidence and clinical guidelines.

Main Results:

• Detailed explanation of the complex hemostatic abnormalities in ESKD.
• Identification of common hemostatic challenges faced by CKD patients.
• Discussion of limited but available evidence for antiplatelet and anticoagulant use.

Conclusions:

• CKD patients present unique and co-existing risks of bleeding and thrombosis.
• A deeper understanding of hemostasis in ESKD is crucial for effective clinical management.
• Further research and clear guidelines are needed to optimize therapy for these patients.