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Is there a cardiovascular protective effect of aspirin in chronic kidney disease patients? A systematic review and meta-analysis

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Abstract

Purpose

To perform a systematic review and meta-analysis to evaluate the cardiovascular prevention effect of aspirin among patients with chronic kidney disease (CKD).

Methods

A comprehensive literature search was conducted in Embase, PubMed, and Cochrane library (up to March 2019) without language limitations. Randomized control trials (RCT) and observational studies that met the inclusion and exclusion criteria were included. Two reviewers independently extracted data, and evaluated study quality using modified Jadad score for RCTs and Newcastle–Ottawa Scale for observational study. A meta-analysis was conducted in the Stata 15.0 software using the DerSimonian and Laird random-effects model.

Results

1768 references were identified from literature searching. Four RCTs and four cohort studies that reported the cardiovascular prevention outcome of aspirin in CKD patients (38,341 participants) were included in this review. The pooled data revealed that aspirin had no significant prevention effect on cardiovascular events among CKD patients (RR = 0.96, 95% CI, 0.59–1.13). There was also no significant reduction in cardiovascular mortality and all-cause mortality. Although we found no significant increased risk in major bleeding events, there was a statistically significant increased risk of minor bleeding events (RR = 2.57, 95% CI, 1.60–4.13) and renal events (RR = 1.30, 95% CI, 1.02–1.65) for aspirin use.

Conclusion

Our review indicated that aspirin use in CKD patients had no prevention effect on cardiovascular events and no statistically significant reduction in risk of cardiovascular or all-cause mortality, with a significant increased risk of minor bleeding and renal events.

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Acknowledgements

We thank Dr. Qing He for providing very useful comments while performing this review.

Author information

BQ and YH contributed equally to this review. They had full access to all the study data and take responsibility for the integrity of the data and the accuracy of the results. They contributed to the study development, quality assessment, data analysis and manuscript writing. LW and HL were responsible for literature search, identifying relevant studies and data collection. Hu was responsible for chart production and creating the figures. ML, the corresponding author, managed the study development and guided the writing of the manuscript.

Correspondence to Mingquan Li.

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The authors declare that no conflict of interest exists.

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This review was based on published studies. Therefore, ethical approval and informed consent are not required for this type of study.

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Qu, B., He, Y., Wu, L. et al. Is there a cardiovascular protective effect of aspirin in chronic kidney disease patients? A systematic review and meta-analysis. Int Urol Nephrol 52, 315–324 (2020). https://doi.org/10.1007/s11255-019-02350-8

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Keywords

  • Aspirin
  • Chronic kidney disease
  • Cardiovascular event
  • Prevention
  • Meta-analysis