title: Haemostasis in chronic kidney disease.
abstract: The coagulation system has gained much interest again as new anticoagulatory substances have been introduced into clinical practice. Especially patients with renal failure are likely candidates for such a therapy as they often experience significant comorbidity including cardiovascular diseases that require anticoagulation. Patients with renal failure on new anticoagulants have experienced excessive bleeding which can be related to a changed pharmacokinetic profile of the compounds. However, the coagulation system itself, even without any interference with coagulation modifying drugs, is already profoundly changed during renal failure. Coagulation disorders with either episodes of severe bleeding or thrombosis represent an important cause for the morbidity and mortality of such patients. The underlying reasons for these coagulation disorders involve the changed interaction of different components of the coagulation system such as the coagulation cascade, the platelets and the vessel wall in the metabolic conditions of renal failure. Recent work provides evidence that new factors such as microparticles (MPs) can influence the coagulation system in patients with renal insufficiency through their potent procoagulatory effects. Interestingly, MPs may also contain microRNAs thus inhibiting the function of platelets, resulting in bleeding episodes. This review comprises the findings on the complex pathophysiology of coagulation disorders including new factors such as MPs and microRNAs in patients with renal insufficiency.
authors.affiliation: Schwerpunkt Nephrologie, I. Medizinische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Mainz, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Lutz
authors.forename: Julia
authors.initials: J
authors.lastname: Menke
authors.forename: Daniel
authors.initials: D
authors.lastname: Sollinger
authors.forename: Helmut
authors.initials: H
authors.lastname: Schinzel
authors.forename: Klaus
authors.initials: K
authors.lastname: Thürmel
mesh_terms: D017152:Antibodies, Antiphospholipid / Q000032:analysis; D000925:Anticoagulants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D001777:Blood Coagulation / Q000502:physiology; D001778:Blood Coagulation Disorders / Q000503:physiopathology*; D001792:Blood Platelets / Q000502:physiology; D004730:Endothelium, Vascular / Q000502:physiology; D006470:Hemorrhage / Q000150:complications; D006487:Hemostasis; D006801:Humans; D018384:Oxidative Stress / Q000502:physiology; D051437:Renal Insufficiency / Q000150:complications; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D013927:Thrombosis / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants
keywords: bleeding disorders; chronic kidney disease; haemostasis; thrombophilia; uraemia