BACKGROUND Patients with chronic kidney disease (CKD) tend to experience both thrombotic and hemorrhagic complications; however, the pathophysiology remains unclear. This study aimed to identify the underlying mechanisms and characteristics of hemostatic problems in patients with CKD and to demonstrate the role of kidney transplantation (KT) in correcting these hemostatic abnormalities. METHODS In this retrospective observational study, 557 KT recipients who did not receive perioperative plasmapheresis and who did not exhibit graft failure within 1 month after KT were included. RESULTS KT recipients demonstrated increased levels of homocysteine and D-dimer. A total of 80.9% of patients exhibited ≥1 thrombophilic factor at pre-transplantation, and the proportion of these patients decreased to 47% at 28th post-operative day (P<.001). The renal function of patients with no thrombophilic factors was better than that of patients with ≥1 thrombophilic factor at all post-operative assessments (P<.001). The duration of pre-operative dialysis significantly correlated with the thrombotic tendency of patients with CKD before and after KT. CONCLUSIONS Patients with CKD can exhibit hypercoagulability, which might be caused by reduced renal function per se. Both HD and PD can aggravate the prothrombotic tendency of patients with CKD via different mechanisms. Most thrombophilic factors in patients with CKD were corrected after KT.