Thrombosis in the Uremic Milieu-Emerging Role of 'Thrombolome'

Chronic kidney disease (CKD) is characterized by retention of a number of toxins, which unleash cellular damage. CKD environment with these toxins and a host of metabolic abnormalities (collectively termed as uremic milieu) is highly thrombogenic. CKD represents a strong and independent risk factor for both spontaneous venous and arterial (post-vascular injury) thrombosis. Emerging evidence points to a previously unrecognized role of some of the pro-thrombotic uremic toxins. Here we provide an overview of thrombosis in CKD and an update on indolic uremic toxins, which robustly increase tissue factor, a potent pro-coagulant, in several vascular cell-types enhancing thrombosis. This panel of uremic toxins, which we term ‘thrombolome’ (thrombosis and metabolome), represents a novel risk factor for thrombosis and can be further explored as biomarkers for post-vascular interventional thrombosis in patients with CKD.