Kuang-Chih Hsiao1, Jing-Yang Huang2, Chun-Te Lee3, Tung-Wei Hung4, Yung-Po Liaw5, Horng-Rong Chang6. 1. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Nephrology, Department of Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan. 2. Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan. 3. Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan. 4. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Nephrology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan. 5. Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan; Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan. Electronic address: liawyp@csmu.edu.tw. 6. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Nephrology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan. Electronic address: chrcsmu@gmail.com.
Abstract
BACKGROUND: The benefit of reducing the risk of stroke against increasing the risk of renal progression associated with antiplatelet therapy in patients with advanced chronic kidney disease (CKD) is controversial. METHODS: We enrolled 1301 adult patients with advanced CKD treated with erythropoiesis stimulating agents from January 1, 2002 to June 30, 2009 from the 2005 Longitudinal Health Insurance Database in Taiwan. All of the patients were followed until the development of the primary or secondary endpoints, or the end of the study (December 31, 2011). The primary endpoint was the development of ischemic stroke, and the secondary endpoints included hospitalization for bleeding events, cardiovascular mortality, all-cause mortality, and renal failure. The adjusted cumulative probability of events was calculated using multivariate Cox proportional regression analysis. RESULTS: Adjusted survival curves showed that the usage of aspirin was not associated with ischemic stroke, hospitalization for bleeding events, cardiovascular mortality or all-cause mortality, however, it was significantly associated with renal failure. In subgroup analysis, aspirin use was associated with renal failure in the patients with no history of stroke (HR, 1.41; 95% CI, 1.14-1.73), and there was a borderline interaction between previous stroke and the use of aspirin on renal failure (interaction p=0.0565). CONCLUSIONS: There was no significant benefit in preventing ischemic stroke in the patients with advanced CKD who received aspirin therapy. Furthermore, the use of aspirin was associated with the risk of renal failure in the patients with advanced CKD without previous stroke.
BACKGROUND: The benefit of reducing the risk of stroke against increasing the risk of renal progression associated with antiplatelet therapy in patients with advanced chronic kidney disease (CKD) is controversial. METHODS: We enrolled 1301 adult patients with advanced CKD treated with erythropoiesis stimulating agents from January 1, 2002 to June 30, 2009 from the 2005 Longitudinal Health Insurance Database in Taiwan. All of the patients were followed until the development of the primary or secondary endpoints, or the end of the study (December 31, 2011). The primary endpoint was the development of ischemic stroke, and the secondary endpoints included hospitalization for bleeding events, cardiovascular mortality, all-cause mortality, and renal failure. The adjusted cumulative probability of events was calculated using multivariate Cox proportional regression analysis. RESULTS: Adjusted survival curves showed that the usage of aspirin was not associated with ischemic stroke, hospitalization for bleeding events, cardiovascular mortality or all-cause mortality, however, it was significantly associated with renal failure. In subgroup analysis, aspirin use was associated with renal failure in the patients with no history of stroke (HR, 1.41; 95% CI, 1.14-1.73), and there was a borderline interaction between previous stroke and the use of aspirin on renal failure (interaction p=0.0565). CONCLUSIONS: There was no significant benefit in preventing ischemic stroke in the patients with advanced CKD who received aspirin therapy. Furthermore, the use of aspirin was associated with the risk of renal failure in the patients with advanced CKD without previous stroke.