Table 2.

Factors influencing hemostasis in CKD

Factors Predisposing for BleedingProcoagulant Factors
Platelet abnormalities including subnormal dense granule contentAtherosclerosis and diffuse endothelial damage
Reduction in intracellular ADP and serotoninDysfunctional activated protein C metabolism
Impaired release of the platelet α-granule protein and β-thromboglobulinBoth elevated plasminogen activator inhibitor-1 to tissue-type plasminogen activator ratios and inhibition of plasmin by increased levels of lipoprotein(a)
Enhanced intracellular cAMP and abnormal mobilization of platelet Ca2+Defects in the expression of glycoprotein GPIb (the receptor for von Willebrand factor)
Abnormal platelet arachidonic acid metabolism
Defective cyclo-oxygenase activity
Abnormality of the activation-dependent binding activity of GPIIb/IIIa
Increased formation of vascular PGI2
Altered von Willebrand factor
Indirectly:
Presence of uremic toxins, especially parathyroid hormone
Anemia/altered blood rheology
Erythropoietin deficiency
Specific drug treatment (e.g., nonsteroidal anti-inflammatory drugs)
  • ADP, adenosine diphosphate; GP, glycoprotein; PG, prostaglandin. Adapted from references.37,38,41