Aspirin for Primary and Secondary Prevention of Mortality, Cardiovascular Disease, and Kidney Failure in the Chronic Renal Insufficiency Cohort (CRIC) StudyPlain-Language Summary

Jonathan J. Taliercio; Georges Nakhoul; Ali Mehdi; Wei Yang; Daohang Sha; Jesse D. Schold; Scott Kasner; Matthew Weir; Mohamed Hassanein; Sankar D. Navaneethan; Geetha Krishnan; Radhika Kanthety; Alan S. Go; Rajat Deo; Claudia M. Lora; Bernard G. Jaar; Teresa K. Chen; Jing Chen; Jiang He; Mahboob Rahman; Lawrence J. Appel, MD, MPH; Debbie L. Cohen, MD; Harold I. Feldman, MD, MSCE; James P. Lash, MD; Robert G. Nelson, MD, PhD, MS; Panduranga S. Rao, MD; Vallabh O. Shah, PhD, MS; Mark L. Unruh, MD, MS

Kidney Medicine (Nov 2022)

Aspirin for Primary and Secondary Prevention of Mortality, Cardiovascular Disease, and Kidney Failure in the Chronic Renal Insufficiency Cohort (CRIC) StudyPlain-Language Summary

Jonathan J. Taliercio,
Georges Nakhoul,
Ali Mehdi,
Wei Yang,
Daohang Sha,
Jesse D. Schold,
Scott Kasner,
Matthew Weir,
Mohamed Hassanein,
Sankar D. Navaneethan,
Geetha Krishnan,
Radhika Kanthety,
Alan S. Go,
Rajat Deo,
Claudia M. Lora,
Bernard G. Jaar,
Teresa K. Chen,
Jing Chen,
Jiang He,
Mahboob Rahman,
Lawrence J. Appel, MD, MPH,
Debbie L. Cohen, MD,
Harold I. Feldman, MD, MSCE,
James P. Lash, MD,
Robert G. Nelson, MD, PhD, MS,
Panduranga S. Rao, MD,
Vallabh O. Shah, PhD, MS,
Mark L. Unruh, MD, MS

Affiliations

Jonathan J. Taliercio: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Department of Kidney Medicine, Glickman Urological and Kidney Institute University, Cleveland, Ohio; Address for Correspondence: Jonathan J. Taliercio, DO, FASN, Program Director, Nephrology and Hypertension Fellowship, Assistant Professor of Medicine; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Department of Kidney Medicine, Glickman Urological and Kidney Institute, 9500 Euclid Ave, Q7, Cleveland, OH 44195.
Georges Nakhoul: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Department of Kidney Medicine, Glickman Urological and Kidney Institute University, Cleveland, Ohio
Ali Mehdi: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Department of Kidney Medicine, Glickman Urological and Kidney Institute University, Cleveland, Ohio
Wei Yang: Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Daohang Sha: Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Jesse D. Schold: Colorado Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz, Aurora, Colorado
Scott Kasner: Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
Matthew Weir: Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Mohamed Hassanein: Division of Nephrology and Hypertension, University of Mississippi Medical Center Division of Nephrology, Jackson, Mississippi
Sankar D. Navaneethan: Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
Geetha Krishnan: Department of Kidney Medicine, Glickman Urological and Kidney Institute University, Cleveland, Ohio
Radhika Kanthety: University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
Alan S. Go: Division of Nephrology, UCSF School of Medicine, San Francisco, California; Division of Research, Kaiser Permanente Northern California, Oakland, California
Rajat Deo: Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Claudia M. Lora: Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
Bernard G. Jaar: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Nephrology Center of Maryland, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
Teresa K. Chen: Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
Jing Chen: Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana
Jiang He: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
Mahboob Rahman: Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Lawrence J. Appel, MD, MPH
Debbie L. Cohen, MD
Harold I. Feldman, MD, MSCE
James P. Lash, MD
Robert G. Nelson, MD, PhD, MS
Panduranga S. Rao, MD
Vallabh O. Shah, PhD, MS
Mark L. Unruh, MD, MS

Journal volume & issue: Vol. 4, no. 11
p. 100547

Abstract

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Rationale and Objective: Chronic kidney disease is a risk enhancing factor for cardiovascular disease (CVD) and mortality, and the role of aspirin use is unclear in this population. We investigated the risk and benefits of aspirin use in primary and secondary prevention of CVD in the Chronic Renal Insufficiency Cohort Study. Study Design: Prospective observational cohort. Setting & Participants: 3,664 Chronic Renal Insufficiency Cohort participants. Exposure: Aspirin use in patients with and without preexisting CVD. Outcomes: Mortality, composite and individual CVD events (myocardial infarction, stroke, and peripheral arterial disease), kidney failure (dialysis and transplant), and major bleeding. Analytical Approach: Intention-to-treat analysis and multivariable Cox proportional hazards model to examine associations of time varying aspirin use. Results: The primary prevention group was composed of 2,578 (70.3%) individuals. Mean age was 57 ± 11 years, 46% women, 42% Black, and 47% had diabetes. The mean estimated glomerular filtration rate was 45 mL/min/1.73 m2. Median follow-up was 11.5 (IQR, 7.4-13) years. Aspirin was not associated with all-cause mortality in those without preexisting cardiovascular disease (CVD) (HR, 0.84; 95% CI, 0.7-1.01; P = 0.06) or those with CVD (HR, 0.88; 95% CI, 0.77-1.02, P = 0.08). Aspirin was not associated with a reduction of the CVD composite in primary prevention (HR, 0.97; 95% CI, 0.77-1.23; P = 0.79) and in secondary prevention because the original study design was not meant to study the effects of aspirin. Limitations: This is not a randomized controlled trial, and therefore, causality cannot be determined. Conclusions: Aspirin use in chronic kidney disease patients was not associated with reduction in primary or secondary CVD events, progression to kidney failure, or major bleeding.

Published in Kidney Medicine

ISSN: 2590-0595 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the genitourinary system. Urology
Website: https://www.journals.elsevier.com/kidney-medicine

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