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Related Concept Videos

Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
Chronic Kidney Disease II: Clinical Manifestations01:24

Chronic Kidney Disease II: Clinical Manifestations

Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration

Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area. This equation is...
Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance01:25

Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance

In healthy individuals, serum creatinine levels remain stable due to a balance between its constant production—primarily from muscle metabolism—and renal excretion. Creatinine is freely filtered by the glomeruli, making it a valuable marker for estimating renal function. When the glomerular filtration rate (GFR) decreases, the kidneys can only eliminate less creatinine, causing serum levels to rise.Serum creatinine concentration is widely used to estimate creatinine clearance (Clcr), a...

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Updated: Jun 5, 2026

Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

Low-Dose Rivaroxaban and Cardiovascular Events in Advanced Kidney Disease: The TRACK Randomized Clinical Trial.

Sunil V Badve1,2, Vlado Perkovic3, Vivekanand Jha1,4,5

  • 1The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.

JAMA
|June 4, 2026
PubMed
Summary

Low-dose rivaroxaban did not reduce cardiovascular events in advanced chronic kidney disease (CKD) patients. The drug significantly increased major bleeding risk, highlighting safety concerns for this population.

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Last Updated: Jun 5, 2026

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Published on: February 2, 2021

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Advanced chronic kidney disease (CKD) affects 10-15% of patients annually with cardiovascular events.
  • Antithrombotic therapies' effects on cardiovascular events in advanced CKD are not well-understood.

Purpose of the Study:

  • To evaluate if low-dose rivaroxaban reduces adverse cardiovascular events compared to placebo in advanced CKD patients.
  • To assess the safety and efficacy of rivaroxaban in this high-risk population.

Main Methods:

  • A randomized, double-blind, placebo-controlled trial involving 1458 patients with CKD stage 4-5 or on dialysis.
  • Patients received either rivaroxaban 2.5 mg twice daily or placebo.
  • The primary outcome was a composite of cardiovascular death, myocardial infarction, stroke, or peripheral artery disease events; major bleeding was the primary safety outcome.

Main Results:

  • Low-dose rivaroxaban did not significantly reduce the composite cardiovascular outcome (HR, 1.09; P=.46).
  • Major bleeding occurred more frequently in the rivaroxaban group (8.8%) compared to placebo (6.0%) (HR, 1.51; P=.04).
  • The trial was stopped early for lack of efficacy.

Conclusions:

  • Low-dose rivaroxaban is not effective in reducing cardiovascular events in patients with advanced CKD.
  • Rivaroxaban use in this population is associated with a significantly higher risk of major bleeding.
  • These findings suggest caution when considering antithrombotic therapy in advanced CKD patients.