Antiplatelet agents for chronic kidney disease

Palmer, Suetonia C.; Micco, Lucia Di; Razavian, Mona; Craig, Jonathan C.; Perkovic, Vlado; Pellegrini, Fabio; Jardine, Meg; Webster, Angela C; Zoungas, Sophia; Strippoli, Giovanni F.M.

doi:10.1002/14651858.cd008834.pub2

Cited by 72 publications

(57 citation statements)

References 117 publications

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“…28 A CV event may afford an opportunity for the clinician to intervene on the trajectory of these patients by aggressively mitigating subsequent morbidity and mortality associated with these events. Pooled data from clinical trials suggest evidence-based therapies, such as statins, 29 antiplatelet drugs, 30 β-receptor antagonists, 31 and angiotensin-converting enzyme inhibitors 32 have similar risk reduction profiles in patients with CKD not receiving dialysis as the general population and should be instituted when appropriate in CKD patients. Yet, previous studies have shown that a care gap exists for CKD patients after a CV event.…”

Section: Discussionmentioning

confidence: 99%

Risk of End-Stage Renal Disease and Death After Cardiovascular Events in Chronic Kidney Disease

et al. 2014

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Sunnybrook Health Sciences Center (SHSC) is a tertiary-care hospital affiliated with the University of Toronto which serves a diverse Background-Patients with chronic kidney disease stages 3 to 5 (glomerular filtration rate <60 mL/min/1.73m2 ) are at increased risk of cardiovascular (CV) disease when compared with patients with less severe chronic kidney disease. How CV events modify the subsequent risk of progression to end-stage-renal disease (ESRD) or all-cause mortality (ACM) before ESRD is not well known. Methods and Results-This

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Section: Discussionmentioning

confidence: 99%

Risk of End-Stage Renal Disease and Death After Cardiovascular Events in Chronic Kidney Disease

et al. 2014

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“…A comprehensive review of the literature is out of the scope of this article, but suffice to say that there is an increasing body of research regarding the use of antiplatelets and oral anticoagulants in the CKD population 39 . A recent metaanalysis suggested that antiplatelet agents do reduce myocardial infarction in such patients but with significant increases in major bleeding, which may outweigh any potential benefits 40 . Data published on major bleeding events in dialysis patients gives a frequency of events of 2.5% per person-year, increasing to 4.4% with the use of aspirin alone and…”

Section: The Use Of Antiplatelet Agents In Uraemiamentioning

confidence: 99%

The role of platelets in the prognosis of renal disease

Forbes¹,

Ashman²,

Yaqoob³

2013

OA Nephrology

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IntroductionPlatelets were first discovered in 1842, identified as 'little globules' or 'granular masses'. Since then, our understanding of these small nonnucleated cells has massively increased, and over the years the humble platelet has been found to be a critical player in many physiological processes. Here, we explore the role of platelets in patients with renal diseases and examine their significance in outcomes. ConclusionIt is clear that, far from being mere 'particles in the blood', platelets are remarkable and exciting cells that have highly evolved and intricate functions spanning far beyond just haemostasis, encompassing many other physiological processes.

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“…Drugs that are used in primary and secondary prevention strategies to lower stroke risk associated with these risk factors in the general population (including aspirin, warfarin, and statins) may be ineffective or even increase the risk of stroke in people with ESRD (7)(8)(9). In addition, novel risk factors specific to having ESRD (accelerated calcific atherosclerosis, platelet dysfunction, anemia, and frequent anticoagulation for those on hemodialysis) might increase stroke risk but may affect the risks of ischemic and hemorrhagic strokes differently (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Risk of Stroke in Patients with ESRD

Masson

Kelly

Craig

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives This study aimed to determine absolute and excess stroke risks in people with ESRD compared with the general population.Design, setting, participants, & measurements This cohort study used data linkage between the Australia and New Zealand Dialysis and Transplant Registry and hospital and death records for 10,745 people with ESRD in New South Wales from 2000 to 2010. For the general population, Australian Institute of Health and Welfare hospital usage records and Australian Bureau of Statistics census data were used. Rates and standardized incidence rate ratios of hospitalization with a stroke were calculated.Results People with ESRD had 640 hospitalizations with stroke in 49,472 person-years of follow-up (1294 per 100,000 person-years), and people in the general population had 338,392 hospitalizations with stroke (212 per 100,000 person-years), an incidence rate ratio of 3.32 (95% confidence interval, 3.31 to 3.33). Excess risk was greater for women (incidence rate ratio, 5.14; 95% confidence interval, 5.11 to 5.18) than men (incidence rate ratio, 2.52; 95% confidence interval, 2.51 to 2.54; P for interaction ,0.001) and decreased with age. People ages 35-39 years old with ESRD had an 11 times increased risk of stroke (incidence rate ratio, 11.08; 95% confidence interval, 9.41 to 13.05), and risk in people ages $85 years old increased 2-fold (incidence rate ratio, 2.04; 95% confidence interval, 1.87 to 2.23; P for interaction ,0.001). Excess risk was greater for intracerebral hemorrhage (incidence rate ratio, 4.18; 95% confidence interval, 4.11 to 4.26) than ischemic stroke (incidence rate ratio, 3.43; 95% confidence interval, 3.40 to 3.45; P for interaction ,0.01).Conclusions People with ESRD have a substantially higher risk of stroke, particularly women and young people, and hemorrhagic stroke. Future work could investigate effective and safe interventions for primary and secondary prevention of stroke in people with ESRD.

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Antiplatelet agents for chronic kidney disease

Abstract: To evaluate the benefits and harms of antiplatelet therapy in patients with any form of kidney disease, including patients with CKD not receiving renal replacement therapy (RRT), patients receiving any form of dialysis, and kidney transplant recipients.

Cited by 72 publications

References 117 publications

Risk of End-Stage Renal Disease and Death After Cardiovascular Events in Chronic Kidney Disease

Risk of End-Stage Renal Disease and Death After Cardiovascular Events in Chronic Kidney Disease

The role of platelets in the prognosis of renal disease

Risk of Stroke in Patients with ESRD

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