Dialysis Toolkit for Severe Thrombocytopenia in Patients with Acute Kidney Injury

Abstract

Acute kidney injury (AKI) in the setting of severe
thrombocytopenia represents a formidable challenge in
nephrology, where both the underlying disease and
therapeutic interventions carry a high risk of bleeding.
Conditions such as lupus nephritis, thrombotic
thrombocytopaenic purpura (TTP), haemolytic uraemic
syndrome (HUS), haematological malignancies,
chemotherapy-induced marrow suppression, and severe
viral infections including dengue or sepsis-related
disseminated intravascular coagulation often present with
simultaneous kidney dysfunction and profound
thrombocytopenia. In such renothrombocytopenic
syndromes, initiation of kidney replacement therapy (KRT)
is often lifesaving but complicated by the heightened risk
of haemorrhage because of various factors including
anticoagulation use, vascular access placement, and fragile
haemostasis. This article reviews the unique challenges of
dialysis in patients with thrombocytopenia and proposes
a structured “Dialysis Toolkit” for clinicians.
Keywords: Acute kidney injury, bleeding diathesis, dialysis,
haemodialysis, rapidly progressive renal failure, renal
replacement therapy, thrombocytopenia,