Tran L, Pannier B, Lacolley P, et al. - Given that endothelial dysfunction, one of various reasons of arterial alterations in end-stage kidney disease (kidney failure), represents a possible link between early vascular aging and the risk of thrombosis or bleeding in this condition, therefore, researchers assessed this by comparing associations between arterial stiffness and endothelial/coagulation factors among 55 patients on hemodialysis and 57 age-/gender-matched controls. Patients with kidney failure had higher markers of endothelial dysfunction, neutrophil extracellular traps and tissue factor-positive extracellular vesicles. Multiple regression analysis revealed a correlation of prothrombin fragments 1 and 2, D-dimer, factor VIII as well as of monocyte-derived tissue factor-positive extracellular vesicles with higher carotid-femoral pulse wave velocity. The occurrence of in vivo hypercoagulability with decreased thrombin production in platelet-rich plasma was noted in patients with kidney failure, likely explaining the opposing thrombotic as well as bleeding tendencies in renal failure cases. Arteriosclerosis was found to be more closely associated with a prothrombotic state. Therefore, coagulation alterations together with arterial stiffness highlight a major treatment challenge for anticoagulant and antiplatelet drug use.