Table 3.
Studies of the safety and efficacy of aspirin for prevention of CV events in CKD
| Study | Study Design | Predictor Variable | Comparator | Duration (y) | Sample (eGFR mean ±SD or median[IQR]) | Outcome, RR (95% CI) |
|---|---|---|---|---|---|---|
| NDD-CKD | ||||||
| UK-HARP-I50 (2005) | RCT | Aspirin 100 mg daily | Placebo (2×2 design w/simvastatin) | 1.0 | 242 NDD-CKD pts (SCr≥1.7, eGFR NR), 73 HD pts, 133 KTRs w/no known CAD | CV events: not assessed; Major bleeding: 0.66 (0.19-2.31); Minor bleeding: 2.8 (1.5-5.3) |
| HOT post hoc51 (2010) | RCT | Aspirin 75 mg daily | Placebo | 3.8 | 18,597 w/diastolic HTN w/no known CAD, of which 3,083 w/eGFR 45-59 (55 [52-58] vs. 55 [52-58]), 536 w/eGFR <45 (40 [34-43] vs. 39 [32-43]) | CV events: 0.85 (0.73-0.98) overall, 0.91 (0.76-1.09) in eGFR ≥60, 0.85 (0.61-1.17) in eGFR 45-59, 0.34 (0.17-0.67) in eGFR <45; Major bleeding: 2.04 (1.05-3.96) |
| JPAD52 (2011) | RCT | Aspirin 81 or 100 mg daily (physician discretion) | Nothing (open label) | 4.4 | 2,523 JP DM pts w/no known CAD (74±31), of which 632 w/eGFR <60 (mean eGFR NR) | CV events: 1.36 (0.73-2.54) overall, SS in eGFR 60-89, NS in eGFR <60; Major bleeding: 1.70 (0.43-6.72) |
| Major, et al.53 (2016) | MA | Aspirin | Control | N/A | 3 trials, all w/no known CAD (eGFR NR) | CV events: 0.92 (0.49-1.73); CHD: 0.79 (0.34-1.87); ; major bleed: 1.98 (1.11-3.52); Minor bleed: 2.70 (1.66-4.39) |
| Palmer, et al.54 (2012) | MA | Anti-platelet therapy | Control | N/A | 31 trials in pts w/or at risk for CAD (eGFR NR) | Fatal/nonfatal MI: 0.66 (0.51-0.87); CV death: 0.91 (0.60-1.36); Major bleeding: 1.29 (CI 0.69-2.42); Minor bleeding: 1.70 (CI 1.44-2.02) |
| CKD-5D | ||||||
| DOPPS56 (2007) | Nested case-control | Aspirin | No aspirin | 1.9 | 28,320 prevalent HD pts | CV events: 1.08 (1.02-1.14); Fatal/nonfatal MI: 1.21 (1.06-1.38); Stroke: 0.82 (0.69-0.98); GI bleed: 1.01 (0.88-1.17); Subdural hematoma: 0.56 (0.30-1.07) |
Relative risks reported for the DOPPS study were calculated using adjusted models.
Abbreviations: CAD, coronary artery disease; CHD, coronary heart disease; CKD-5D, dialysis-dependent chronic kidney disease; CV, cardiovascular; eGFR, estimated glomerular filtration rate (in mL/min/1.73 m2); GI, gastrointestinal HD, hemodialysis; HOT, Hypertension Optimal Treatment; IQR, interquartile range; JPAD, Japanese Primary Prevention of Atherosclerosis with Aspirin in Diabetics; MI, myocardial infarction; NDD-CKD, non-dialysis-dependent chronic kidney disease; NR, not reported; NS, non-significant; RCT, randomized controlled trial; RR, relative risk; SD, standard deviation; SS, statistically significant; UK-HARP-I, United Kingdom Heart and Renal Protection-I; KTRs, kidney transplant recipients; JP, Japanese; DM, diabetes mellitus; pts, patients; MA, meta-analysis