Nadroparin calcium is a low molecular weight heparin (LMWH) that is commonly used in the prevention of deep venous thrombosis (DVT) and the treatment of acute thromboembolic diseases. The aim of study was to examine the accuracy of dosing strategy to achieve the desired target of anticoagulation in advanced CKD. This prospective study was performed in patients admitted to a nephrology center from 2021 to 2023 years, who started anticoagulant treatment with nadroparin during their in-hospital stay for prophylactic or therapeutic indications. The dosing strategy was 42 anti-Xa IU/kg/day for prophylaxis of DVT and 86 anti-Xa IU/kg for therapeutic anticoagulation in all patients. Anti-Xa levels were measured 3-5 hours after the third nadroparin dose to assess anticoagulation in all cases. The study included 124 patients; 56 patients with stage 4-5 CKD and 68 patients on haemodialysis. 94 patients (75.8%) received nadroparin for a therapeutic indication, while 30 patients (24.2%) received it as prophylaxis of DVT. In patients receiving nadroparin for a therapeutic indication, 58 patients (61.7%) reached the therapeutic target anti-Xa levels, while 24 (25.5%) patients had peak anti-Xa levels below the therapeutic target and 12 (12.8%) were over-anticoagulated. There was an inverse relationship between the proportion of patients who were adequately anticoagulated and CKD stage; 73.9%, 65.0% and 54.9% of patients reached the target peak anti-Xa levels in CKD stage 4, 5 and 5D respectively. In patients receiving nadroparin for prophylaxis of DVT, 43.3% reached the target anti-Xa levels, while 33.3% had anti-Xa levels below this range and 23.4% were over-anticoagulated. The target therapeutic levels of anti-Xa were not achieved in advanced CKD, especially in patients on haemodialysis by standard nadroparin dosing. To ensure adequate anticoagulation, we recommend using individualized dosing adjustments based on monitoring of anti-Xa levels for the prevention of thromboembolic and hemorrhagic complications.