Traditionally, aspirin has been recommended for the prevention of primary and secondary cardiovascular disease and death in the general population and in high-risk groups such as patients with chronic kidney disease (CKD). Recent emerging data suggests a lack of benefit in the primary prevention of cardiovascular disease (CVD) and an increased bleeding risk in the general population. To date, many studies exclude patients with CKD, who are at higher CVD risk. This study evaluates the risks and benefit of aspirin in CVD risk reduction in people with moderate to severe CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We found that aspirin use in patients with CKD was not associated with reduction in primary or secondary CVD, progression to kidney failure, or major bleeding.

The primary exposure was self-reported aspirin use, which may change annually. Adjudicated clinical outcomes were ascertained at 6-month intervals and broadly grouped into composite and individual endpoints. The composite of CVD events included definite, probable, and possible acute myocardial infarction (MI), definite and probable stroke, and peripheral arterial disease. Peripheral arterial disease included amputation or revascularization. Stroke included hemorrhage (intraparenchymal, subarachnoid) and cerebral infarction. Patients who did not have a self-reported CVD event prior to CRIC enrollment were allocated to the primary prevention group. Kidney failure included either dialysis or kidney transplant. Cardiovascular death included death from atherosclerotic coronary heart disease, cerebrovascular, other atherosclerotic disease, and other cardiovascular disease. To explore a risk benefit analysis of aspirin use and risk of major bleed, we used previously accepted published ICD-9/10 codes broadly grouped into upper and lower gastrointestinal bleeding, intracerebral bleed, subarachnoid bleed, and nontraumatic intracranial bleed.

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Mishita
Jornal co-ordinator
Journal of Clinical & Experimental Nephrology