Haemodialysis in haemophilia B: a case report. Challenges and strategies from a nephrology perspective

Haemophilia B, the result of factor IX deficiency, is a complex clinical condition that is particularly challenging when associated with kidney failure. This is primarily due to the high bleeding risk associated with kidney replacement therapies. The increase in life expectancy in haemophilia patients has resulted in a greater prevalence of age-related comorbidities, including chronic kidney disease. Nevertheless, a consensus has yet to be reached regarding the most suitable dialysis modality for this population. In this report, we present a case study of a 68-year-old male patient suffering from severe haemophilia B, who was administered prophylactic Idelvion® (albutrepenonacog alfa) and subsequently underwent arteriovenous fistula creation and haemodialysis initiation without encountering any bleeding complications. This narrative review, from the perspective of a nephrologist, addresses the epidemiology and main clinical considerations regarding dialysis in haemophilia B. These considerations include the choice between haemodialysis and peritoneal dialysis, vascular access planning, haemostasis management with factor IX replacement, and anticoagulation strategies aimed at minimising bleeding risk. A review of the extant literature and clinical reports published between 2020 and 2025 was conducted, integrating documented experiences and available guideline recommendations. In addition, we put forward a series of pragmatic recommendations that are -underpinned by a systematic decision-making framework. Through meticulous multidisciplinary planning incorporating the utilisation of factor IX concentrates, meticulous surgical techniques, and tailored anticoagulation protocols, patients with haemophilia B can be deemed eligible for chronic haemodialysis with a reasonable degree of safety.