How does CKD affect platelet function?

• A. Hyperactive platelets leading to thrombocytosis
• B. Uremic platelet dysfunction increases bleeding tendency
• C. No effect on platelets
• D. Increases platelet aggregation and clot risk

Answer: (B)

Chronic kidney disease, especially with uremia, causes qualitative platelet dysfunction, not a lack of platelets. Uremic toxins interfere with how platelets adhere to injured vessels and how they aggregate in response to stimuli, so the platelet plug doesn’t form effectively even when platelet counts are normal. This impaired platelet function leads to a tendency to bleed, visible as prolonged bleeding times and mucosal bleeding. The interaction with von Willebrand factor can be disrupted as well, further impairing primary hemostasis. Dialysis may partially improve this dysfunction, but the problem often persists until uremia is better controlled. Clinically, this shows up as easy bruising, prolonged bleeding after minor injuries, and mucosal bleeding. Treatments that can help acutely include desmopressin to boost release of vWF and factor VIII, and antifibrinolytics for mucosal bleeds, along with avoiding NSAIDs and addressing the underlying uremia.