Bleeding Risks With Renal Disease

Abstract Uremia leads to a multitude of changes in the plasma that disturbs the hemostasis milieu. Intrinsic platelet dysfunction, accumulating products such as nitric oxide (NO), anemia, dialysis-induced vascular changes, and disturbances in platelet-vessel wall interactions all contribute to the resulting bleeding diathesis. Bleeding is usually mucosal, although life-threatening intracranial and gastrointestinal bleeding can rarely occur. This potential probleeding state cannot be characterized by commonly used tests of the coagulation system. Dialysis helps to correct this coagulopathy. Erythropoietin-stimulating agents, DDAVP, conjugated estrogen, cryoprecipitate, and platelet transfusions all work in different ways and are varyingly successful in managing acute bleeding.