Hemostasis disorders in chronic renal failure

Dialysis patients with CRF show a fibrinolysis defect at the level of plasminogen activation. The fibrinolysis defect in CRF deepens as renal function declines. Reduced fibrinolysis may be responsible, along with other factors, for the development of thrombosis, atherosclerosis and their thrombotic complications. A number of important and relevant questions, which are more or less interrelated, continue to be left without clear-cut answers. These include, for instance, what is the relationship between fibrinolysis defects in CRF and "prothrombotic" metabolic disorders? To what extent, if at all, does hypofibrinolysis normalize during treatment of these metabolic disorders? Indeed, is there a causative relationship between the decrease in fibrinolysis and thrombotic complications in patients with CRF?