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Antiplatelet agents for chronic kidney disease
Suetonia C Palmer1, Lucia Di Micco, Mona Razavian
1Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand. suetonia.palmer@otago.ac.nz.
The Cochrane Database of Systematic Reviews
|March 2, 2013
Summary
Antiplatelet agents reduce myocardial infarction in chronic kidney disease (CKD) patients but increase bleeding risks. The benefits may not outweigh harms for those with early-stage CKD and low cardiovascular event risk.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Antiplatelet agents are standard for cardiovascular event prevention.
- Their efficacy and safety in chronic kidney disease (CKD) patients are uncertain due to differing event prevalence and increased bleeding risks.
Purpose of the Study:
- To evaluate the effects of antiplatelet treatment versus control or other antiplatelet agents.
- To assess cardiovascular and adverse kidney outcomes in individuals with CKD.
Main Methods:
- Systematic review and meta-analysis of 50 randomized controlled trials (27,139 participants).
- Included trials compared antiplatelet agents against placebo or other agents in CKD populations.
- Data extracted for population, interventions, outcomes; risk ratios (RR) and 95% confidence intervals (CI) calculated using random-effects model.
Main Results:
- Antiplatelet agents reduced myocardial infarction (RR 0.87, 95% CI 0.76 to 0.99) but not all-cause mortality, cardiovascular mortality, or stroke.
- Increased risk of major (RR 1.33, 95% CI 1.10 to 1.65) and minor bleeding (RR 1.49, 95% CI 1.12 to 1.97).
- Reduced access thrombosis but no effect on dialysis suitability; no differences by antiplatelet type or CKD stage.
Conclusions:
- Antiplatelet therapy reduces myocardial infarction but elevates major bleeding risk in CKD patients.
- Potential for harms to outweigh benefits in individuals with low cardiovascular event risk, including early CKD stages without overt atherosclerotic disease.
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