Global Hemostasis Testing in Chronic Kidney Disease-Are They Better Predictors of Bleeding and Thrombosis Risk?

Chronic kidney disease (CKD) affects over 10% of the global population and significantly increases the risk of cardiovascular disease as well as arising bleeding. There are alterations in hemostasis, which are multifactorial, involving complex interactions between coagulation, platelets, and the vessel wall. Hemostasis evaluation in CKD is critical for the optimal management of patients. However, conventional coagulation testing and renal function do not fully reflect the hemostatic alterations and do not adequately represent the risk of bleeding and/or thrombosis in patients with CKD. Global hemostatic assays, including thrombin and fibrin generation assays, provide a more wholesome assessment of the process, including the interaction between procoagulants, anticoagulants, platelets, and fibrinolysis. This review critically appraises published studies reporting the use of global coagulation assays to evaluate hemostasis in patients with CKD, as well as associated clinical outcomes.