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Different impact of aspirin on renal progression in patients with predialysis advanced chronic kidney disease with or without previous stroke

  • Kuang-Chih Hsiao
    Affiliations
    Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Division of Nephrology, Department of Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
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  • Jing-Yang Huang
    Affiliations
    Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
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  • Chun-Te Lee
    Affiliations
    Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan
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  • Tung-Wei Hung
    Affiliations
    Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Division of Nephrology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan

    School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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  • Yung-Po Liaw
    Correspondence
    Correspondence to: Y.-P. Liaw, Department of Public Health and Institute of Public Health, Chung Shan Medical University, No. 110, Sec. 1 Jianguo N. Rd., Taichung City 40201, Taiwan.
    Affiliations
    Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan

    Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan
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  • Horng-Rong Chang
    Correspondence
    Correspondence to: H.-R. Chang, Division of Nephrology, Department of Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Road, South District, Taichung 40201, Taiwan.
    Affiliations
    Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Division of Nephrology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan

    School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Published:November 21, 2016DOI:https://doi.org/10.1016/j.ejim.2016.11.009

      Highlights

      • A nationwide cohort study.
      • Aspirin has no benefit in preventing ischemic stroke.
      • Aspirin is associated with the risk of renal failure.

      Abstract

      Background

      The benefit of reducing the risk of stroke against increasing the risk of renal progression associated with antiplatelet therapy in patients with advanced chronic kidney disease (CKD) is controversial.

      Methods

      We enrolled 1301 adult patients with advanced CKD treated with erythropoiesis stimulating agents from January 1, 2002 to June 30, 2009 from the 2005 Longitudinal Health Insurance Database in Taiwan. All of the patients were followed until the development of the primary or secondary endpoints, or the end of the study (December 31, 2011). The primary endpoint was the development of ischemic stroke, and the secondary endpoints included hospitalization for bleeding events, cardiovascular mortality, all-cause mortality, and renal failure. The adjusted cumulative probability of events was calculated using multivariate Cox proportional regression analysis.

      Results

      Adjusted survival curves showed that the usage of aspirin was not associated with ischemic stroke, hospitalization for bleeding events, cardiovascular mortality or all-cause mortality, however, it was significantly associated with renal failure. In subgroup analysis, aspirin use was associated with renal failure in the patients with no history of stroke (HR, 1.41; 95% CI, 1.14–1.73), and there was a borderline interaction between previous stroke and the use of aspirin on renal failure (interaction p = 0.0565).

      Conclusions

      There was no significant benefit in preventing ischemic stroke in the patients with advanced CKD who received aspirin therapy. Furthermore, the use of aspirin was associated with the risk of renal failure in the patients with advanced CKD without previous stroke.

      Keywords

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