Aspirin and cardiovascular primary prevention in non-endstage chronic kidney disease: A meta-analysis

Major, Rupert; Oozeerally, Issaam; Dawson, Simon; Riddleston, Helen; Gray, Laura J.; Brunskill, Nigel J.

doi:10.1016/j.atherosclerosis.2016.06.013

Cited by 40 publications

(25 citation statements)

References 21 publications

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“…In a more recent meta-analysis that focused only on primary prevention studies in CKD, 3 trials-Hypertension Optimal Treatment trial, Heart and Renal Protection trial, and Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes trial-were identified, providing data for 4468 participants. 24 Overall, there was no statistically significant reduction in major cardiovascular events including stroke (RR, 0.92; 95% CI, 0.49-1.73; P ¼ 0.79), but there was a high level of heterogeneity between studies (I 2 ¼ 71%; P ¼ 0.06) and only 1 trial (Heart and Renal Protection study) was CKD specific.…”

Section: Primary Prevention Of Stroke In Ckd Antiplateletsmentioning

confidence: 91%

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Kelly

Rothwell

2020

Kidney International

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Chronic kidney disease is strongly associated with an increased risk of stroke, small vessel disease, and vascular dementia. Common vascular factors for stroke, such as hypertension, diabetes, and atrial fibrillation, are more prevalent in patients with chronic kidney disease, accounting for this association. However, factors unique to these patients, such as uremia, oxidative stress, and mineral and bone abnormalities, as well as dialysis-related factors are also believed to contribute to risk. Despite improvements in stroke treatment and survival in the general population, the rate of improvement in patients with chronic kidney disease, especially those who are dialysis dependent, has lagged behind. There is a lack of or conflicting evidence that those with renal disease, particularly when advanced or older, consistently derive benefit from currently available preventive and therapeutic interventions for stroke in the general population. In this review, we explore the complexities and challenges of these interventions in the population with renal disease.

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Section: Primary Prevention Of Stroke In Ckd Antiplateletsmentioning

confidence: 91%

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Kelly

Rothwell

2020

Kidney International

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“…Aspirin is widely used and recommended as the first-line antiplatelet drug in the clinical setting. However, a previous meta-analysis indicated that aspirin had no apparent benefits on the primary prevention of CVD in the CKD population [20]. Thus, the efficacy and safety of antiplatelet therapy, like aspirin, in patients with CKD remain controversial.…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Antiplatelet therapy for the prevention of atherosclerosis in chronic kidney disease (ALTAS-CKD) patients: study protocol for a randomized clinical trial

Xiong

et al. 2021

Trials

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Background Cardiovascular disease (CVD) is the most common complication and the leading cause of death in patients with chronic kidney disease (CKD). Accelerated atherosclerosis is a pathophysiological process that is vital to the occurrence of cardiovascular complications associated with CKD. Abnormal platelet activation is not only the leading cause of atherosclerosis but also plays a critical role in the occurrence of thrombotic events. Currently, antiplatelet drugs are commonly used as a secondary prevention strategy for high blood pressure, obesity, diabetes, and ischemic heart disease and can reduce the risk of CVD in the susceptible population. However, the benefits and evidence of using antiplatelet agents in patients with CKD remain controversial. This study aimed to determine whether antiplatelet therapy can safely prevent atherosclerosis in patients with CKD in the primary care setting. Methods/design The ALTAS-CKD study is a multicenter, prospective, randomized, double-blind, placebo-controlled trial of 554 adult patients with stage 3–5 non-dialysis-dependent CKD recruited from 10 territory medical centers in China. A secured web-based computer randomization system will be used to administer aspirin 100 mg once daily or a matching inactive placebo for 36 months. The primary endpoint will be the occurrence of atherosclerosis, as measured by carotid ultrasonography. The secondary endpoints will be combined cardiovascular events, all-cause mortality, and 50% decrease in the estimated glomerular filtration rate. Trial registration {2a} Current controlled trials number: ChiCTR1900021393. Registered on 18 February 2019.

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“…52 A meta-analysis of these 3 trials demonstrated no difference in CV events, but a significant increase in both major and minor bleeding. 53…”

Section: Aspirinmentioning

confidence: 99%

Management of Traditional Cardiovascular Risk Factors in CKD: What Are the Data?

Gregg

Hedayati

2018

American Journal of Kidney Diseases

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Patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) are 10 times more likely to die of cardiovascular (CV) diseases than the general population, and dialysis-dependent patients are at even higher risk. Although traditional CV risk factors are highly prevalent in individuals with CKD, these patients were often excluded from studies targeting modification of these risks. Although treatment of hypertension is beneficial in CKD, the best target blood pressure has not been established. Trial data showed that renin-angiotensin-aldosterone blockade may prevent CV events in patients with CKD. The risks of aspirin may equal the benefits in NDD-CKD samples, and there are no trials testing aspirin in dialysis-dependent patients. Lipid-lowering therapy improves CV outcomes in NDD-CKD, but not in dialysis-dependent patients. Strict glycemic control prevents CV events in nonalbuminuric individuals, but showed no benefit in those with baseline albuminuria with albumin excretion > 300mg/g, and there are no data in dialysis-dependent patients. Data for lifestyle modifications, such as weight loss, physical activity, and smoking cessation, are mostly observational and extrapolated from non-CKD samples. This comprehensive review summarizes the best existing evidence and current clinical guidelines for modification of traditional risk factors for the prevention of CV events in patients with CKD and identifies knowledge gaps.

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Aspirin and cardiovascular primary prevention in non-endstage chronic kidney disease: A meta-analysis

Cited by 40 publications

References 21 publications

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Antiplatelet therapy for the prevention of atherosclerosis in chronic kidney disease (ALTAS-CKD) patients: study protocol for a randomized clinical trial

Management of Traditional Cardiovascular Risk Factors in CKD: What Are the Data?

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