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.

High-sensitivity Troponin T in hemodialysis patients: a randomized placebo-controlled sub-study investigating angiotensin-II-blockade, variation over time and associations with clinical outcome

“…Interestingly, we found that use of aspirin vs. non-use was associated with fewer TnT-peaks during follow-up. There is a paucity of definitive data concerning the efficacy of aspirin in dialysis patients and most observational studies suffer from confounding by indication explaining why some studies found aspirin use to be associated with increased CV mortality or adverse CV-events [ 42 – 44 ]. Our study, although not designed to study the effects of aspirin, suggest that aspirin may be beneficial in terms of preventing asymptomatic ischemia in HD patients consistent with the Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guideline [ 45 ].…”

High-sensitivity Troponin T in hemodialysis patients: a randomized placebo-controlled sub-study investigating angiotensin-II-blockade, variation over time and associations with clinical outcome

“…Interestingly, we found that use of aspirin vs. non-use was associated with fewer TnT-peaks during follow-up. There is a paucity of definitive data concerning the efficacy of aspirin in dialysis patients and most observational studies suffer from confounding by indication explaining why some studies found aspirin use to be associated with increased CV mortality or adverse CV-events [ 42 – 44 ]. Our study, although not designed to study the effects of aspirin, suggest that aspirin may be beneficial in terms of preventing asymptomatic ischemia in HD patients consistent with the Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guideline [ 45 ].…”

Prescription pattern, short-term outcomes, and its determinants in patients with chronic kidney disease attending a tertiary care hospital

“…showed that antiplatelet therapy among CKD patients, reduced the risk of myocardial infarction by 13% (RR = 0.87, 95% CI: 0.76, 0.99), and on the contrary, increased the risk of major (RR 1.33, 95% CI 1.10, 1.65) and minor (RR 1.49, 95% CI: 1.12, 1.97) bleeding. [14]…”

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

“…11 In a large Cochrane review of 50 randomized controlled trials (RCTs) (27,139 participants) of antiplatelet treatment for the prevention of cardiovascular outcomes in CKD, antiplatelet agents reduced the risk of myocardial infarction (RR, 0.87; 95% confidence interval [CI], 0.76-0.99), but not all-cause mortality (RR, 0.93; 95% CI, 0.8-1.06), cardiovascular mortality (RR, 0.89; 95% CI, 0.70-1.12), or stroke (RR, 1.00; 95% CI, 0.58-1.72). 22 Antiplatelet agents increased the risk of major (RR, 1.33; 95% CI, 1.10-1.65) and minor (RR, 1.49; 95% CI, 1.12-1.97) bleeding. Although few studies were available for direct comparison, meta-regression analysis indicated no differences in the relative benefits or harms of treatment by type of antiplatelet agent.…”

High-sensitivity Troponin T in hemodialysis patients: a randomized placebo-controlled sub-study investigating angiotensin-II-blockade, variation over time and associations with clinical outcome

“…Interestingly, we found that use of aspirin vs. non-use was associated with fewer TnT-peaks during follow-up. There is a paucity of definitive data concerning the efficacy of aspirin in dialysis patients and most observational studies suffer from confounding by indication explaining why some studies found aspirin use to be associated with increased CV mortality or adverse CV-events [ 42 – 44 ]. Our study, although not designed to study the effects of aspirin, suggest that aspirin may be beneficial in terms of preventing asymptomatic ischemia in HD patients consistent with the Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guideline [ 45 ].…”

Prescription pattern, short-term outcomes, and its determinants in patients with chronic kidney disease attending a tertiary care hospital

“…showed that antiplatelet therapy among CKD patients, reduced the risk of myocardial infarction by 13% (RR = 0.87, 95% CI: 0.76, 0.99), and on the contrary, increased the risk of major (RR 1.33, 95% CI 1.10, 1.65) and minor (RR 1.49, 95% CI: 1.12, 1.97) bleeding. [14]…”

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

“…11 In a large Cochrane review of 50 randomized controlled trials (RCTs) (27,139 participants) of antiplatelet treatment for the prevention of cardiovascular outcomes in CKD, antiplatelet agents reduced the risk of myocardial infarction (RR, 0.87; 95% confidence interval [CI], 0.76-0.99), but not all-cause mortality (RR, 0.93; 95% CI, 0.8-1.06), cardiovascular mortality (RR, 0.89; 95% CI, 0.70-1.12), or stroke (RR, 1.00; 95% CI, 0.58-1.72). 22 Antiplatelet agents increased the risk of major (RR, 1.33; 95% CI, 1.10-1.65) and minor (RR, 1.49; 95% CI, 1.12-1.97) bleeding. Although few studies were available for direct comparison, meta-regression analysis indicated no differences in the relative benefits or harms of treatment by type of antiplatelet agent.…”

High-sensitivity Troponin T in hemodialysis patients: a randomized placebo-controlled sub-study investigating angiotensin-II-blockade, variation over time and associations with clinical outcome

“…Interestingly, we found that use of aspirin vs. non-use was associated with fewer TnT-peaks during follow-up. There is a paucity of definitive data concerning the efficacy of aspirin in dialysis patients and most observational studies suffer from confounding by indication explaining why some studies found aspirin use to be associated with increased CV mortality or adverse CV-events [ 42 – 44 ]. Our study, although not designed to study the effects of aspirin, suggest that aspirin may be beneficial in terms of preventing asymptomatic ischemia in HD patients consistent with the Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guideline [ 45 ].…”

Prescription pattern, short-term outcomes, and its determinants in patients with chronic kidney disease attending a tertiary care hospital

“…showed that antiplatelet therapy among CKD patients, reduced the risk of myocardial infarction by 13% (RR = 0.87, 95% CI: 0.76, 0.99), and on the contrary, increased the risk of major (RR 1.33, 95% CI 1.10, 1.65) and minor (RR 1.49, 95% CI: 1.12, 1.97) bleeding. [14]…”

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

“…11 In a large Cochrane review of 50 randomized controlled trials (RCTs) (27,139 participants) of antiplatelet treatment for the prevention of cardiovascular outcomes in CKD, antiplatelet agents reduced the risk of myocardial infarction (RR, 0.87; 95% confidence interval [CI], 0.76-0.99), but not all-cause mortality (RR, 0.93; 95% CI, 0.8-1.06), cardiovascular mortality (RR, 0.89; 95% CI, 0.70-1.12), or stroke (RR, 1.00; 95% CI, 0.58-1.72). 22 Antiplatelet agents increased the risk of major (RR, 1.33; 95% CI, 1.10-1.65) and minor (RR, 1.49; 95% CI, 1.12-1.97) bleeding. Although few studies were available for direct comparison, meta-regression analysis indicated no differences in the relative benefits or harms of treatment by type of antiplatelet agent.…”