Abstract: FR-OR100
ATTACK (Aspirin To Target Arterial events in Chronic Kidney Disease): A Multicentre Randomised Trial of Aspirin vs. Usual Care for the Primary Prevention of Cardiovascular Events in Patients with CKD
Session Information
- High-Impact Clinical Trials
October 23, 2026 | Location: Bluebird Ballroom, Convention Center
Abstract Time: 10:30 AM - 10:45 AM
Category: CKD (Non-Dialysis)
- 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Gallagher, Hugh, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, England, United Kingdom
- Fraser, Simon DS, University of Southampton, Southampton, England, United Kingdom
- Wilding, Sam, University of Southampton, Southampton, England, United Kingdom
- Northey, Joshua, University of Southampton, Southampton, England, United Kingdom
- Taal, Maarten W., University Hospitals of Derby and Burton NHS Foundation Trust, Derby, England, United Kingdom
- Stevens, Paul E., East Kent Hospitals University NHS Foundation Trust, Canterbury, England, United Kingdom
- Henderson, Robert Anthony, Nottingham University Hospitals NHS Trust, Nottingham, England, United Kingdom
- Lown, Mark, University of Southampton, Southampton, England, United Kingdom
- Hartshorne, Liz, University of Nottingham, Nottingham, England, United Kingdom
- Dumbleton, Jennifer Susan, Protas, Oxford, United Kingdom
- Daunt, Wendy, University of Nottingham, Nottingham, England, United Kingdom
- Lampitt, Rosy Anne, South Tees Hospitals NHS Foundation Trust, Middlesbrough, England, United Kingdom
- Townend, Jonathan N., Queen Elizabeth Hospital Birmingham, Birmingham, England, United Kingdom
- Todd, Susan, University of Reading, Reading, England, United Kingdom
- Roderick, Paul J., University of Southampton, Southampton, England, United Kingdom
Background
CKD is strongly associated with cardiovascular disease (CVD). In the general population the use of aspirin for primary prevention of CVD reduces atherosclerotic vascular events but increases bleeding; the balance of benefits and harms in people with CKD is unclear.
Methods
We recruited adults with CKD (G1-4) and no history of CVD through primary care practices across the UK and randomly assigned them to receive aspirin 75 mg od or no aspirin in an open label design. The trial was powered at a sample size of 25210. The primary outcome was time to first major CV event (non-fatal MI, non-fatal stroke, CV death [excluding intracranial haemorrhage/other fatal CV bleeding]). Secondary outcomes reported here include time to first major bleed and all-cause mortality.
Results
Recruitment was adversely affected by the COVID pandemic. 4633 participants were randomised between March 2019 and December 2023 (2317 aspirin, 2316 control) and followed for a mean of 3.1 years. The primary outcome was observed in 56 (2.4%) and 76 (3.3%) participants in aspirin and non-aspirin arms respectively (Sub HR [SHR] 0.73, 95% CI 0.52 to 1.03). There were 29 (10 intracranial) major bleeding events in the aspirin arm vs. 19 (9 intracranial) in the non-aspirin arm (SHR 1.54, 95% CI 0.86 to 2.74). Death occurred during follow-up in 124 (5.4%) of the aspirin arm vs. 113 (4.9%) of the non-aspirin arm (HR 1.11, 95% CI 0.86 to 1.43).
Conclusion
The ATTACK trial provides inconclusive evidence on whether aspirin reduces the risk of first atherosclerotic events in people with CKD. Whilst a clinically meaningful 27% reduction in the primary outcome was observed, the results were not statistically significant. This may be because the trial was underpowered, but the findings are also consistent with a lack of effect. Further trials or a meta-analysis combining data from similar studies are required to answer the research question.
Cumulative incidence curve of time to first major vascular event
Funding
- Government Support - Non-U.S.