Bleeding in patients with renal impairment – a current perspective

Bleeding complications are a frequent and clinically significant problem in patients with chronic kidney disease (CKD), with prevalence increasing as kidney function declines, and in those receiving dialysis. The bleeding tendency in CKD is multifactorial: arising from platelet dysfunction, uremic/inflammatory states, renal anaemia and the common concurrent use of anticoagulants in this population. Together, these mechanisms all contribute to impairment in haemostasis and increased risk of both spontaneous and procedural-haemorrhages. Current bleeding risk assessment tools perform poorly in the CKD population, limiting their utility for guiding clinical decision making. Emerging evidence suggests that albuminuria, as an independent marker for both renal dysfunction and haemorrhage risk, may improve bleeding risk stratification in this cohort. This review summarises the pathophysiological mechanisms underlying bleeding in CKD and the impact of dialysis and declining renal function. It also highlights the unmet need for more accurate, CKD-specific bleeding risk assessment tools.