Low-Dose Aspirin for Prevention of Cardiovascular Disease in Patients with Chronic Kidney Disease

Abstract

BackgroundChronic kidney disease (CKD) is a major risk factor for the development of cardiovascular disease (CVD). Previous trials have investigated the effects of low-dose aspirin on CVD prevention in patients with diabetes; however, patients with CKD were not examined. The role of aspirin in diabetics is controversial, and the available literature is contradictory. Therefore, we studied whether low-dose aspirin would be beneficial for patients with CKD, a group that is at high risk for CVD.MethodFrom a total of 25340 patients with CKD, 1884 recipients of low-dose aspirin (100 mg/day) were paired 1∶1 with non-recipients for analysis using propensity score matching. The primary endpoint was the development of atherosclerotic CVD, including coronary arterial disease, stroke, and peripheral arterial disease. Secondary endpoints included death from any cause, bleeding events, doubling of serum creatinine, and renal death.ResultsThe incidence of a primary endpoint of any atherosclerotic CVD was significantly higher in the aspirin users than in the non-users (P<0.001). Secondary endpoints, including all-cause mortality and composite bleeding events, were not significantly different between the aspirin users and the non-users. However, the doubling of serum creatinine levels (P = 0.001) and renal death (P = 0.042) were significantly associated with the use of aspirin.ConclusionThese results suggest that the use of low-dose aspirin in patients with CKD may have harmful consequences related to the development of CVD and renal progression.

Prescription Rates of Cardiovascular Medications in a Large UK Primary Care Chronic Kidney Disease Cohort

“…Evidence for its use in CKD is limited and appears to show limited benefit with possible increased risk of bleeding [26]. Observational data also suggests that aspirin may increase CV risk and bleeding risk [27]. Therefore whilst higher levels of CV disease may make universal use of aspirin in CKD an attractive proposition an increased risk of bleeding may negate any benefit.…”

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

“…Kim et al performed a retrospective analysis of 1884 individuals receiving aspirin matched to 1884 not receiving aspirin [11].…”

“…However, only one relevant trial is presently registered with clinicaltrials.gov [9]. Whilst its efficacy may be higher in the prevention of CVD events [10], there is also a potentially greater risk of bleeding in CKD [11]. Previous meta-analyses have only considered the broader category of 'anti-platelets' and have included individuals with end-stage renal failure and established CVD [12].…”

Efficacy of Statin Treatment in Early-Stage Chronic Kidney Disease

“…As described previously [26], the probability for statin prescription was determined using a multiple logistic regression analysis model (C statistic = 0.624; Hosmer and Lemeshow goodness-of-fit test, P = 0.1494), which included demographics and clinical and laboratory values (age, sex, BMI, medical history of diabetes, hypertension, and previous CVD; baseline eGFR; presence of proteinuria, hemoglobin, albumin, calcium, phosphorus, and uric acid; cholesterol, triglycerides, and HDL-cholesterol levels; and the prescription of RAAS blockers, beta blockers, CCBs, diuretics, and aspirin). After PS matching, the balance in baseline covariates between the two groups was assessed using the standardized mean difference test, paired t-test, and McNemar’s test.…”