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 anemia, and the common concurrent use of anticoagulants in this population. Together, these mechanisms all contribute to impairment in hemostasis and increased risk of both spontaneous and procedural-hemorrhages. 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 hemorrhage risk, may improve bleeding risk stratification in this cohort. This review summarizes 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.