ABSTRACT
According to the US Renal Data System 2014 Annual Data Report, the incidence of end-stage renal disease (ESRD) has now plateaued aer steadily increasing over the past three decades.1 Since 2000, there has been about a 57.4% increase in the size of the population undergoing hemodialysis and peritoneal dialysis. Among these patients on hemodialysis and peritoneal dialysis, hospitalization rates and average length of stay have been declining over recent years. Infection has become a more frequent cause of hospitalizations with an increase in 21.8% between 1993 and 2012. Other causes of hospitalizations, such as vascular access procedures, have been declining though continue to be prevalent. Vascular access-related complications account for 14%–17% of hospitalizations per year for dialysis patients with annual costs exceeding $1 billion in the United States.2 Vascular access thrombosis is the most common and expensive hemodialysis complication.3 In addition to vascular access thrombosis, patients maintained by chronic hemodialysis also are susceptible to other thrombotic complications such as ischemic heart disease and cerebral strokes.4-6 Casserly and Dember, as well as Paulson, have suggested that thrombophilia may be a cause of dialysis access thrombosis in many ESRD patients.7,8 rombophilia may be acquired, genetically determined or a combination of both and leads to a predisposition to thrombosis.9 is chapter examines coagulation abnormalities in ESRD patients, focusing on thrombophilia and management of the hypercoagulable state in ESRD patients.
