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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.

Background There is growing evidence linking nonalcoholic fatty liver disease (NAFLD) with reduced glomerular filtration rate (GFR). Living kidney donors do not have underlying kidney disease, but have reduced GFR as a result of nephrectomy. Whether kidney donation is associated with a higher risk for development or progression of NAFLD is currently unknown. Methods Retrospective evaluation of metabolic parameters and sonographic evidence of NAFLD were performed in 232 living kidney donors and 162 healthy controls. Results A total of 25 donors and 44 controls had NAFLD at baseline. During a mean follow-up of 6.8 years, 6 donors (24%) and 17 controls (38.6%) (P = .29) had a remission of NAFLD, related with decreased body mass index (BMI). The progression of NAFLD fibrosis score was similar in both groups. New onset of NAFLD was observed in 14 (6.8%) donors and 13 (11.01%) controls (P = .211), and was related to increased BMI and a higher baseline Fatty Liver Index score. Neither eGFR nor urine albumin excretion in the donors were related to new onset or progression of NAFLD. Conclusions Reduced kidney function secondary to kidney donation is not associated with increased incidence or progression of NAFLD.