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Although not statistically tested due to small group sizes, this accumulation of the effect of nadroparin on anti-Xa activity with time seems most distinct in patients with MDRD-eGFR [http://www.selleckchem.com/products/carfilzomib-pr-171.html selleckchem] was to evaluate the impact of the clinical guideline on attained anti-Xa levels, and the analysis was not designed to correlate the resulting anti-Xa activities to clinical outcomes. Thus, we did not prospectively document clinical outcomes such as number of bleeding and re-thrombotic events nor was the analysis powered to do so. Considering both the lack of data on adequate LMWH dosage adjustments in renal failure and our results which seem to justify an a priori dosage adjustment, we would like to emphasize the importance of further research. Renal patients constitute a large population for which questions remain regarding LMWH treatment. Differences [http://www.selleckchem.com/products/azd9291.html AZD9291 nmr] between LMWHs should be considered. These nadroparin results cannot be extrapolated to other LMWHs, since the LMWHs differ in pharmacokinetic and pharmacodynamic profiles. Theoretically, nadroparin might even not be the LMWH of choice in patients with reduced renal function, because its relatively small molecular weight renders its elimination mainly dependent on renal function. Tinzaparin, for example, has a higher molecular weight and is less dependent on renal function for its elimination. Therefore, tinzaparin might have a lower risk of accumulation in kidney patients than the smaller LMWHs [4]. Although most dependent on renal [http://en.wikipedia.org/wiki/YES1 YES1] clearance, most evidence of all LMWHs on altered pharmacokinetics exists for the use of enoxaparin [1] including dose-adjusting schemes [4, 12�C14]. Nevertheless, in a national questionnaire among Dutch nephrologists, it was found that in 56% of the Dutch hospitals nadroparin was the LMWH of choice to treat embolic diseases (data not shown). Based on pharmacokinetic modelling of enoxaparin, two studies report that with a loading dose followed by a lower maintenance dose adequate anti-Xa activities are reached in a timely manner without subsequent accumulation [12, 13]. An important limitation of this study is that it is a retrospective analysis and not a clinical randomized trial.