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Kidney Week

Abstract: TH-PO445

Effect of Aspirin on Cardiovascular Events, Mortality, and Bleeding Outcomes in Older Individuals with CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Polkinghorne, Kevan, Monash Medical Centre and Monash University, Melbourne, Victoria, Australia
  • Wetmore, James B., Hennepin County Medical Center, Minneapolis, Minnesota, United States
  • Woods, Robyn L., Monash University, Melbourne, Victoria, Australia
  • Murray, Anne M., Hennepin County Medical Center/Hennepin Healthcare, Minneapolis, Minnesota, United States
  • Mcneil, John James, Monash University, Melbourne, Victoria, Australia
  • Roderick, Paul J., University of Southampton, UK, Southampton, United Kingdom
  • Gallagher, Hugh, Epsom & St Helier NHS Trust, Carshalton, SURREY, United Kingdom
  • Wolfe, Rory, Monash University/Department of Epidemiology & Preventive Medicine, Melbourne, Victoria, Australia
Background

The primary efficacy and safety of aspirin (ASA) in older people with chronic kidney disease (CKD) is unclear. ASPirin in Reducing Events in the Elderly (ASPREE), a large binational (Australia, US) RCT in elderly participants free of diagnosed CVD or disability, found no benefit of aspirin for primary prevention. The ASA To Target Arterial Events In CKD (ATTACK) trial is underway with a primary endpoint of major adverse cardiovascular events (MACE) in patients with CKD. To provide insights into whether ATTACK should consider exclusion of individuals aged >70 years, we examine the effects of daily 100mg ASA on outcomes in ASPREE participants with CKD.

Methods

ASPREE participants with eGFR <60, or ≥60mL/min with urine albumin creatinine ratio (UACR) ≥3mg/mmol, were included in these analyses. MACE was defined as a composite of fatal coronary heart disease, non-fatal myocardial infarction (MI), and fatal and non-fatal ischemic stroke. Other endpoints included all-cause mortality and major hemorrhage. In intention-to-treat time-to-event analyses, Cox proportional hazards models were used to compare the ASA group with the placebo group.

Results

Of 19,114 ASPREE participants, 4,758 had baseline CKD. Median eGFR was 56.2 mL/min/1.73m2 (IQR 50.2, 67.1), median UACR was 1.8 mg/mmol (0.6, 4.8). Sex, age, CVD risk factors, eGFR, and uACR were well-balanced between ASA and placebo groups. Participants with CKD randomized to ASA had a lower risk of MACE (HR 0.77, [95% C.I. 0.61, 0.99], figure), higher rate of major hemorrhage (HR 1.28, [0.98, 1.68]) and similar rate of mortality (HR 1.08, [0.89, 1.32]) compared to placebo.

Conclusion

The balance ofbenefit and harms of treatment with ASA in older people with CKD are unclear and merit ongoing investigation.

Cummulative incidence MACE.

Funding

  • Other NIH Support