Aspirin for Primary and Secondary Prevention of Mortality, Cardiovascular Disease, and Kidney Failure in the Chronic Renal Insufficiency Cohort (CRIC) Study.

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 m. 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;  = 0.06) or those with CVD (HR, 0.88; 95% CI, 0.77-1.02,  = 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;  = 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.