Hallmarks for Thrombotic and Hemorrhagic Risks in Chronic Kidney Disease Patients

Area of Science:

• Nephrology
• Hematology
• Cardiology

Background:

• Chronic kidney disease (CKD) presents a significant global health burden.
• CKD patients experience high rates of thrombotic and hemorrhagic complications, increasing mortality and hospitalization, particularly from cardiovascular diseases.
• Hemostatic alterations in CKD are multifactorial, leading to controversial findings regarding coagulation status.

Purpose of the Study:

• To review the molecular mechanisms of thrombotic and hemorrhagic risk in CKD patients.
• To discuss the impact of these risks on cardiovascular complications.
• To provide evidence and guidance for optimal therapeutic management strategies.

Main Methods:

• Literature review of molecular mechanisms underlying hemostatic alterations in CKD.
• Analysis of contributing factors including endothelial dysfunction, platelet dysfunction, coagulation abnormalities, comorbidities, and dialysis membrane interactions.
• Evaluation of existing evidence on antiplatelet and anticoagulant therapies in end-stage renal disease (ESRD).

Main Results:

• CKD is associated with both prothrombotic and bleeding tendencies due to complex hemostatic dysregulation.
• Endothelial dysfunction, platelet abnormalities, altered coagulation, comorbidities, and dialysis membrane hemoincompatibility are key contributors.
• Limited clinical trial data exists for antithrombotic therapies in ESRD patients, necessitating personalized clinical assessment.

Conclusions:

• Understanding the intricate molecular mechanisms of hemostasis in CKD is vital for managing thrombotic and hemorrhagic risks.
• Personalized clinical evaluation is essential for tailoring antithrombotic therapy in CKD patients.
• Developing hemocompatible dialysis membranes offers a promising strategy to mitigate platelet activation and thrombus formation, potentially reducing cardiovascular complications.