Table 4.
Benefits and adverse effects of different therapies for bleeding in patients with ESKD
| Therapies | Application | Benefits | Adverse Effects |
|---|---|---|---|
| Peritoneal dialysis61 | The preferred treatment for patients with ESKD who are at high risk of bleeding or have active bleeding | Anticoagulant therapy is not required | Peritonitis and loss of nutrients |
| Hemodialysis61 | The only option for patients who are not suitable for peritoneal dialysis because of insufficient clearance or intraperitoneal surgery | Mild or no anticoagulation can reduce the risk of bleeding | Thrombosis |
| Applying estrogen61 | Controlling bleeding in patients with advanced or severe kidney failure. Suitable for both male patients and female patients | Taking effect within 6 h and lasting for 2 wk by intravenous injection (0.6 mg/kg daily for 4–5 d) or taking effect within 2 d and lasting for 5 d by oral administration (25–50 mg/d). Especially suitable for patients who need continuous bleeding control Transdermal estradiol patches (50–100 μg/d, twice per week) are available, whose effects last longer, which could relieve the pain of patients |
Fluid retention, hypertension, and liver injury |
| Transfusion of cryoprecipitate61 | Only used for the emergency treatment of acute and severe bleeding | Rapidly inhibiting bleeding in patients with uremia | Therapeutic effects are short-lived, and not all patients respond Carrying the risk of infection76 |
| Applying DDAVP61 | Controlling bleeding in patients with uremia and preventing bleeding before renal biopsy | Intravenously administered at a dosage of 0.3µg/kg can inhibit bleeding within 1 h; the effect lasts for 8 h. Could also be given subcutaneously Could be given by intranasal route which is well-tolerated and safe |
Repeated administration may cause rapid depletion of vWFs, leading to hypotension, tachycardia, and thrombosis in some cases |
| Transfusion of packed erythrocytes78 | The main means to correct anemia before the use of erythropoiesis-stimulating agent | Bleeding time can be shortened by infusion of concentrated erythrocytes to a hematocrit of 30%61 | Blood volume overload, hyperkalemia, iron overload, blood-borne infection, fever, and allogenic sensitization79 |
| Application of recombinant erythropoietin78 | Maintaining the hemoglobin/hematocrit levels of patients with ESKD61 | Reducing the need for erythrocyte transfusions. Reducing fatigue and improving quality of life79 |
Increased risk of adverse cardiovascular outcomes79 Iron overload79 |
| Applying TXA80 | Should only be used in patients with severe, life-threatening bleeding that has failed to be controlled by other evidence-based treatments | A single small dose of TXA (7.5 mg/kg) intravenously could reduce the need for blood transfusion81 Could be safely used to treat severe hematuria in patients with CKD and PKD80 Could effectively treat massive hemorrhage of the upper digestive tract in hemodialysis patients82 |
Causing ureteral thrombosis and cortical necrosis, leading to acute renal failure. Contraindicated in patients with chronic kidney injuries83 Carrying the risk of systemic epilepsy because it could cross the blood–brain barrier and is neurotoxic83 |
DDAVP, desmopressin; vWFs, von Willebrand factors; TXA, tranexamic acid; PKD, polycystic kidney disease.