Abnormalities in Hemostatic Parameters Related to Hemodialysis in End-stage Kidney Pathology: A Narrative Review

Chronic kidney disease (CKD) is a progressively prevalent global health issue. During the initial phases of the condition, CKD is commonly linked to a tendency for excessive blood clotting. While in the end-stage of disease, patients undergoing hemodialysis have a multitude of hemostatic abnormalities. These include prolonged bleeding time, altered platelet count, prolonged PT and aPTT, elevated FDPs and D-dimer, dysregulated vWF activity, and abnormal thrombin generation. These changes result from a combination of uremic toxicity, endothelial dysfunction, inflammatory states, and the effects of the hemodialysis procedure itself. Understanding these mechanisms is crucial for managing and mitigating the bleeding and thrombotic risks in this patient population. This review aims to systematically investigate the effects of hemodialysis on key hemostasis parameters in CKD patients.