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Updated: Oct 18, 2025
Direct Drug Delivery to Kidney via the Renal Artery
Published on: April 17, 2021
Anticoagulation in patients with kidney failure on dialysis: factor XI as a therapeutic target
John Eikelboom1, Jürgen Floege2, Ravi Thadhani3
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Insights
Chronic kidney disease patients on dialysis face high cardiovascular risks. Factor XI inhibitors show promise as safer anticoagulants to prevent thrombotic events in this population.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Chronic kidney disease affects nearly 10% of the global population, increasing mortality and morbidity.
- Reduced glomerular filtration rate and proteinuria are significant risk factors for cardiovascular disease.
- Patients with kidney failure on dialysis experience the highest risk of cardiovascular events and heart failure.
Purpose of the Study:
- To explore the rationale for anticoagulation therapy in kidney failure patients to mitigate atherothrombotic events.
- To identify limitations of existing anticoagulant therapies in this high-risk group.
- To discuss the potential advantages of Factor XI (FXI) inhibitors as a novel therapeutic strategy.
Main Methods:
- Review of existing literature on anticoagulation in chronic kidney disease and kidney failure.
- Analysis of the role of FXI in thrombosis versus hemostasis.
- Summary of ongoing clinical trials investigating FXI inhibitors in dialysis patients.
Main Results:
- Current anticoagulants (e.g., vitamin K antagonists, direct oral anticoagulants targeting thrombin or FXa) have limitations and bleeding risks in kidney failure patients.
- FXI is identified as a potentially safer anticoagulant target due to its greater role in thrombosis than hemostasis.
- Ongoing studies are evaluating the efficacy and safety of FXI inhibition in patients with kidney failure on dialysis.
Conclusions:
- Anticoagulation is understudied but potentially beneficial for preventing thromboembolism in dialysis patients.
- FXI inhibitors represent a promising new class of anticoagulants with a potentially improved safety profile for kidney failure patients.
- Further research and clinical trials are crucial to establish the role of FXI inhibitors in managing cardiovascular risk in this vulnerable population.
Abstract:
Chronic kidney disease is present in almost 10% of the world population and is associated with excess mortality and morbidity. Reduced glomerular filtration rate and the presence and extent of proteinuria, key domains of chronic kidney disease, have both been shown to be strong and independent risk factors for cardiovascular disease. Patients with kidney failure requiring dialysis are at highest risk for cardiovascular events (e.g., stroke or myocardial infarction), and of developing chronic cardiovascular conditions, such as heart failure. Despite the high burden of cardiovascular disease, there is a paucity of evidence supporting therapies to reduce this risk. Although long-term anticoagulant treatment has the potential to prevent thromboembolism in persons with kidney failure on dialysis, this possibility remains understudied. The limited data available on anticoagulation in patients with kidney failure has focused on vitamin K antagonists or direct oral anticoagulants that inhibit thrombin or factor (F) Xa. The risk of bleeding is a major concern with these agents. However, FXI is emerging as a potential safer target for new anticoagulants because FXI plays a greater part in thrombosis than in hemostasis. In this article, we (i) explain the rationale for considering anticoagulation therapy in patients with kidney failure to reduce atherothrombotic events, (ii) highlight the limitations of current anticoagulants in this patient population, (iii) explain the potential benefits of FXI inhibitors, and (iv) summarize ongoing studies investigating FXI inhibition in patients with kidney failure on dialysis.
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