Dialysis Toolkit for Severe Thrombocytopenia in Patients with Acute Kidney Injury

Abstract

Acute kidney injury (AKI) in the setting of severethrombocytopenia represents a formidable challenge innephrology, where both the underlying disease andtherapeutic interventions carry a high risk of bleeding.Conditions such as lupus nephritis, thromboticthrombocytopaenic purpura (TTP), haemolytic uraemicsyndrome (HUS), haematological malignancies,chemotherapy-induced marrow suppression, and severeviral infections including dengue or sepsis-relateddisseminated intravascular coagulation often present withsimultaneous kidney dysfunction and profoundthrombocytopenia. In such renothrombocytopenicsyndromes, initiation of kidney replacement therapy (KRT)is often lifesaving but complicated by the heightened riskof haemorrhage because of various factors includinganticoagulation use, vascular access placement, and fragilehaemostasis. This article reviews the unique challenges ofdialysis in patients with thrombocytopenia and proposesa structured “Dialysis Toolkit” for clinicians.Keywords: Acute kidney injury, bleeding diathesis, dialysis,haemodialysis, rapidly progressive renal failure, renalreplacement therapy, thrombocytopenia,