Clinic of Internal Medicine Nephrology - Infectious Diseases, Central Rhine Hospital Group, Koblenz, Germany.
Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
Semin Thromb Hemost. 2020 Apr;46(3):342-356. doi: 10.1055/s-0040-1708841. Epub 2020 Apr 7.
Rates of thrombosis and bleeding episodes are both increased in patients with advanced chronic kidney disease (CKD). The pathogenic mechanisms of thrombosis in these patients include platelet activation, increased formation of platelet-leukocyte conjugates, and platelet-derived microparticles, as well as effects of uremic toxins on platelets. On the other side of the coin, platelet hyporeactivity mediated by uremic toxins and anemia contributes to the increased bleeding risk in advanced CKD. Platelets also contribute to the inflammatory environment, thus increasing the risk of cardiovascular diseases in these patients. This review provides insights into the altered platelet function in advanced stages of CKD and their relationship with risks of thrombosis and bleeding. Particularly, the effect of dialysis on platelets will be discussed. Furthermore, therapeutic options with respect to thrombotic disorders as well as bleeding in patients with CKD are reviewed.
在患有晚期慢性肾脏病（CKD）的患者中，血栓形成和出血事件的发生率均增加。这些患者血栓形成的发病机制包括血小板激活、血小板-白细胞缀合物的形成增加以及血小板衍生的微粒，以及尿毒症毒素对血小板的影响。另一方面，尿毒症毒素和贫血介导的血小板反应性降低导致晚期 CKD 出血风险增加。血小板也有助于炎症环境，从而增加这些患者患心血管疾病的风险。本综述深入了解 CKD 晚期血小板功能的改变及其与血栓形成和出血风险的关系。特别是，将讨论透析对血小板的影响。此外，还回顾了 CKD 患者血栓形成疾病和出血的治疗选择。
