Risk factors for major bleeding among patients with chronic kidney disease treated with acetylsalicylic acid.

IF 2.3 4区医学 Q2 PERIPHERAL VASCULAR DISEASE Kidney & blood pressure research Pub Date : 2024-11-11 DOI:10.1159/000542500

Keren Cohen-Hagai, Gil Schwartz Yoskovitz, Meytal Schwartz Yoskovitz, Hadar Haim-Pinhas, Mor Saban, David Pereg, Ori Wand, Ilan Rozenberg, Sydney Benchetrit

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Abstract

Introduction: Individuals with chronic kidney disease (CKD) are at increased risk for thrombotic events and bleeding. Acetylsalicylic acid (ASA), an effective antiplatelet agent, is one of the most frequently used medications for both primary and secondary prevention of cardiovascular disease (CVD). However, it can also contribute to bleeding events due to its inherent antiplatelet effect. The objective of this study was to determine the characteristics of CKD patients at increased risk for bleeding under ASA therapy.

Methods: This retrospective analysis included patients with non-dialysis dependent CKD who were treated with ASA for primary prevention of CVD for at least 3 consecutive months and did not receive anti-coagulants or anti-platelets. Data were collected from electronic medical records from January 2014 to December 2018. CKD diagnosis was based on an estimated glomerular filtration rate of <60 ml/min/1.73 m2. CKD patients who experienced major bleeding events during ASA therapy (bleeding group) vs. all others (control group) were compared. Additional outcomes included first documented non-fatal cardiovascular event and all-cause mortality.

Results: Of the 900 adult CKD patients included in this analysis, 82 (9.1%) had a major bleeding event during 31.6±25.9 months of follow-up. The most common bleeding site was gastrointestinal (52 cases, 63.4% of major bleeding events). Patients who had a major bleeding event were older (76.5±10 vs. 74±10.3 years, P=0.038). On multivariate analysis, age was the most important predictor of major bleeding event (odds ratio 1.029, 95% confidence interval 1.004-1.056).

Conclusions: Given its controversial efficacy in primary prevention of CVD in CKD patients, characterizing those at increased risk for bleeding under ASA therapy is important in the era of tailored medicine. Age, CKD stage and cardiovascular risk are key factors to consider regarding the safety and effectiveness of ASA for CKD patients.

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接受乙酰水杨酸治疗的慢性肾病患者大出血的风险因素。

导言：慢性肾脏病（CKD）患者发生血栓事件和出血的风险增加。乙酰水杨酸（ASA）是一种有效的抗血小板药物，是心血管疾病（CVD）一级和二级预防最常用的药物之一。然而，由于其固有的抗血小板作用，它也可能导致出血事件。本研究旨在确定接受 ASA 治疗的出血风险增加的慢性肾脏病患者的特征：这项回顾性分析包括至少连续 3 个月使用 ASA 治疗心血管疾病一级预防且未接受抗凝剂或抗血小板治疗的非透析依赖型 CKD 患者。数据收集自2014年1月至2018年12月的电子病历。CKD诊断基于估计的肾小球滤过率结果：在纳入本次分析的 900 名成年 CKD 患者中，有 82 人（9.1%）在 31.6±25.9 个月的随访期间发生了大出血事件。最常见的出血部位是胃肠道（52 例，占大出血事件的 63.4%）。发生大出血的患者年龄较大（76.5±10 岁对 74±10.3岁，P=0.038）。在多变量分析中，年龄是预测大出血事件的最重要因素（几率比1.029，95%置信区间1.004-1.056）：鉴于ASA在CKD患者心血管疾病一级预防中的疗效备受争议，在定制医学时代，确定ASA治疗下出血风险增加的人群的特征非常重要。年龄、慢性阻塞性肺病分期和心血管风险是慢性阻塞性肺病患者服用 ASA 的安全性和有效性需要考虑的关键因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Kidney & blood pressure research 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.60%

发文量

审稿时长

6-12 weeks

期刊介绍： This journal comprises both clinical and basic studies at the interface of nephrology, hypertension and cardiovascular research. The topics to be covered include the structural organization and biochemistry of the normal and diseased kidney, the molecular biology of transporters, the physiology and pathophysiology of glomerular filtration and tubular transport, endothelial and vascular smooth muscle cell function and blood pressure control, as well as water, electrolyte and mineral metabolism. Also discussed are the (patho)physiology and (patho) biochemistry of renal hormones, the molecular biology, genetics and clinical course of renal disease and hypertension, the renal elimination, action and clinical use of drugs, as well as dialysis and transplantation. Featuring peer-reviewed original papers, editorials translating basic science into patient-oriented research and disease, in depth reviews, and regular special topic sections, ''Kidney & Blood Pressure Research'' is an important source of information for researchers in nephrology and cardiovascular medicine.