Baaten C, Schröer J, Floege J, et al. - This is a review of current understanding of chronic kidney disease (CKD)-induced aberrations in hemostasis with a special emphasis on platelet abnormalities. Also, it was addressed how prominent changes in vascular integrity, coagulation as well as red blood cell count in CKD could be contributors to altered hemostasis in these high-risk cases. In addition, anti-platelet treatment strategies were analyzed based on CKD-stage.

• With regard to benefits vs risks of antiplatelet therapy for thrombosis prevention, bleeding and clinical outcome, these should be carefully considered in CKD patients, balancing thrombotic vs bleeding risk.

• Nonetheless, there exists an elevated cardiovascular risk in CKD patients despite antiplatelet treatment.

• To optimize as well as develop current and novel anti-platelet treatment strategies, specifically tailored to these high-risk patients, it is essential to acquire deep insights into altered platelet activity in CKD as well as underlying mechanisms.

• A closer investigation of altered platelet function, hemostasis, and anti-platelet therapy in CKD patients is crucial.