The underlying pathology of increased bleeding risk in CKD is multifactorial, and includes dysfunctional platelet-endothelial adhesion as well as reduced platelet aggregation (which is in part due to impairment of the interaction between platelets and vWF).19 The RCT by Sattari et al,19 and the mixed prospective-retrospective cohort trials by Peters et al,20 and Rao and Chandra,21 all demonstrated benefit in patients with reduced kidney function for outcomes including overall bleeding.10 Here, VWF is linked to chronic kidney disease.