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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Article info
Publication history
Published online: November 21, 2016
Accepted:
November 13,
2016
Received in revised form:
November 12,
2016
Received:
August 28,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
