CYP3A4 and chronic kidney disease: Notably, the ageing patient demographic, comorbid conditions and drug-drug interactions may play an important role in the poor clinical outcomes: ageing is linked to a reduction in GFR; cardiovascular risk factors can accelerate CKD progression and raise the baseline risk of bleeding and thromboembolic complications; co-medication with inhibitors of CYP3A4 enzyme system or p-glycoprotein transporter slows the metabolism (enhances bioaccumulation) [9, 23].