Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardiovascular disease (CVD) is a major cause of morbidity and mortality in individuals with chronic kidney disease (CKD). Aspirin is widely used in secondary prevention of cardiovascular disease. Its use in primary prevention, particularly in CKD, is less clear. Previous reviews have offered inconclusive findings for the benefit of aspirin in CKD. Recent trials have been completed that may help provide more conclusive answers in CKD.
Purpose
This study aimed to assess the role of aspirin in the primary prevention of CVD and its associated adverse events in individuals with CKD.
Methods
A pre-defined protocol registered with PROSPERO (CRD42014008860) was used. The OVID Medline and EMBASE databases were searched for studies from 1996 to the 15th September 2020. Abstracts and full-texts were screened independently by two reviewers. Randomised controlled trials that compared aspirin to placebo in individuals with non-endstage CKD without CVD nor primary renal disease were included. The primary outcomes of interests were: CVD, major and minor bleeding events. Secondary outcomes of interest were: all-cause mortality, coronary artery disease and stroke. A meta-analysis was conducted using a random-effects model to calculate a pooled relative risk (RR).
Results
Five trials were included with 434 CVD events in 7,825 individuals with CKD. Aspirin offered no statistically significant benefit in reduction of CVD events (RR = 0.79, 95%CI: 0.57, 1.09) but significantly increased both minor (RR = 2.62, 95%CI: 1.64, 4.20) and major bleeding (RR= 1.51, 95%CI: 1.13, 2.02) events compared to placebo. Aspirin conferred no benefit for all-cause mortality (RR= 0.89, 95%CI: 0.64, 1.22), coronary heart disease (RR= 0.66, 95%CI: 0.27, 1.63) and stroke (RR= 0.94, 95%CI: 0.55, 1.58).
Conclusion
Aspirin cannot be recommended for the primary prevention of CVD in individuals with CKD as it offers no conclusive benefit and increases the risk of bleeding. Other strategies to optimise CVD primary prevention in individuals with CKD should be prioritised.
The role of aspirin for the primary prevention of cardiovascular disease in individuals with chronic kidney disease