Anemia and Disorders of Hemostasis in Chronic Kidney Disease

Anemia is one of the most common complications of chronic kidney disease. Decreased erythropoietin synthesis, iron deficiency, and hepcidin axis disturbances are the main causes of anemia in chronic kidney disease and guidelines prioritize iron replacement in the treatment. The potential benefits and risks should be considered when deciding to use erythropoietin treatment. Recently, hypoxia inducible factor-prolyl hydroxylase inhibitors have emerged as a promising treatment alternative with non-inferior efficacy compared to erythropoietin. However, there may be some theoretical safety concerns during long-term treatment with these drugs. Hemostatic mechanisms are also impaired in chronic kidney disease, which increases the risk of both bleeding and thrombosis. The use of anticoagulant drugs may lead to higher rates of bleeding complications because of impaired renal clearance.