{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T23:25:33Z","timestamp":1791329133231,"version":"4.3.1"},"reference-count":189,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Patients with end-stage renal disease (ESRD) undergoing renal replacement therapies, including hemodialysis, continuous renal replacement therapy (CRRT), and peritoneal dialysis, face a dual risk of thrombosis and bleeding complications. Conventional coagulation monitoring parameters, such as activated partial thromboplastin time (APTT) and prothrombin time (PT), have substantial limitations in uremic patients and fail to accurately reflect their true hemostatic status. In recent years, emerging molecular biomarkers, including thrombin-antithrombin complex (TAT), plasmin-\u03b12-antiplasmin complex (PIC), soluble thrombomodulin (sTM), tissue-type plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), tPA\u2013PAI-1 complex (tPAIC) and anti-factor Xa activity (Anti-Xa), have been investigated as complementary biomarkers for assessing thrombin generation, fibrinolytic activation, endothelial injury, fibrinolytic dysregulation, and anticoagulant drug effect in selected dialysis-related settings. This review summarizes the biological characteristics of these biomarkers, their clinical utility across different dialysis modalities, recent advances in detection methodologies, and strategies for multimarker monitoring. Current evidence suggests that these biomarkers may provide complementary mechanistic information beyond conventional assays regarding coagulation activation, fibrinolytic status, endothelial injury, and anticoagulant drug effect. However, dialysis-specific outcome evidence remains uneven, and no validated five-marker strategy has yet been established for routine clinical decision-making. Therefore, these biomarkers should currently be viewed as adjunctive and exploratory tools, with potential use in selected scenarios such as CRRT anticoagulation assessment, vascular access risk stratification, and individualized anticoagulant evaluation. However, several challenges remain, including assay standardization, establishment of reference ranges, and cost-effectiveness evaluation. Further prospective studies are needed to validate whether scenario-based single-marker or multimarker interpretation can improve clinically meaningful outcomes, including circuit patency, vascular access survival, bleeding prevention, and individualized anticoagulation management.<\/jats:p>","DOI":"10.3389\/fmed.2026.1869337","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:10:35Z","timestamp":1785409835000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Molecular biomarkers in dialysis-related thrombosis and anticoagulation monitoring: thrombin\u2013antithrombin complex, plasmin-\u03b12-antiplasmin complex, soluble thrombomodulin, tPA\/PAI-1\/tPAIC, and Anti-Xa"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuning","family":"Lin","sequence":"first","affiliation":[{"name":"Medical Laboratory, Xiamen Humanity Hospital, Fujian Medical University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huarong","family":"Lu","sequence":"additional","affiliation":[{"name":"Medical Laboratory, Xiamen Humanity Hospital, Fujian Medical University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyi","family":"Lv","sequence":"additional","affiliation":[{"name":"Medical Laboratory, Xiamen Humanity Hospital, Fujian Medical University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songping","family":"Chen","sequence":"additional","affiliation":[{"name":"Medical Laboratory, Xiamen Humanity Hospital, Fujian Medical University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwei","family":"Jin","sequence":"additional","affiliation":[{"name":"Medical Laboratory, Xiamen Humanity Hospital, Fujian Medical University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e1378","DOI":"10.1016\/s2214-109x(25)00198-6","article-title":"Global, regional, and national prevalence of kidney failure with replacement therapy and associated aetiologies, 1990-2023: a systematic analysis for the global burden of disease study 2023","volume":"13","year":"2025","journal-title":"Lancet Glob Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1001\/jama.2024.16338","article-title":"Dialysis for chronic kidney failure: a review","volume":"332","author":"Flythe","year":"2024","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1016\/j.chest.2018.09.004","article-title":"Continuous renal replacement therapy: who, when, why, and 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