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Updated: Aug 22, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Effects of aspirin on cardiovascular outcomes in patients with chronic kidney disease
Johannes F E Mann1, Philip Joseph2, Peggy Gao2
1Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; KfH Kidney Center, Munich, Germany.
Insights
Aspirin may reduce cardiovascular events in individuals with chronic kidney disease (CKD). This study found aspirin use was associated with a lower risk of primary cardiovascular outcomes in patients with moderate to advanced CKD.
Area of Science:
- Nephrology
- Cardiology
- Clinical Trials
Background:
- Patients with chronic kidney disease (CKD) have a significantly elevated risk of cardiovascular (CV) disease.
- The efficacy of aspirin in mitigating this increased CV risk in CKD patients remains incompletely understood.
Purpose of the Study:
- To investigate whether the cardiovascular benefits of aspirin vary based on baseline kidney function.
- To analyze aspirin's effect on cardiovascular outcomes in participants stratified by estimated glomerular filtration rate (eGFR) within the International Polycap Study-3 (TIPS-3) trial.
Main Methods:
- The study analyzed data from the TIPS-3 trial, which randomized participants without prior cardiovascular disease to receive aspirin (75 mg daily) or placebo.
- Participants were grouped by estimated glomerular filtration rate (eGFR) using a threshold of 60 ml/min/1.73 m² and by eGFR tertiles.
- The primary outcome was a composite of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death.
Main Results:
- In participants with an eGFR < 60 ml/min/1.73 m², aspirin use was associated with a reduced risk of primary outcomes (hazard ratio 0.57; 95% CI 0.34-0.94).
- In contrast, in participants with an eGFR > 60 ml/min/1.73 m², aspirin did not significantly reduce the risk of primary outcomes (hazard ratio 0.95; 95% CI 0.71-1.27).
- Risk reduction with aspirin for the primary outcome was more pronounced at lower eGFR levels, with significant benefit observed in the lowest eGFR tertile.
Conclusions:
- The findings suggest that aspirin may offer a protective effect against cardiovascular events in individuals with moderate to advanced stages of chronic kidney disease.
- Aspirin's benefit in primary cardiovascular prevention appears to be more significant in patients with impaired kidney function.
Abstract:
Patients with chronic kidney disease (CKD) carry a high cardiovascular (CV) risk. Since whether this risk is reduced by aspirin is unclear, we examined if the effect of aspirin on cardiovascular outcomes varied by baseline kidney function in a primary cardiovascular disease prevention trial. The International Polycap Study-3 (TIPS-3) trial had randomized people without previous cardiovascular disease to aspirin (75 mg daily) or placebo. We now examined aspirin versus placebo on cardiovascular events in participants grouped by estimated glomerular filtration rate (eGFR), using a threshold of 60 ml/min/1.73 m2, and by using tertiles of eGFR. The primary outcome was a composite of non-fatal myocardial infarction, non-fatal stroke or cardiovascular death. A total of 5712 participants were randomized with a mean follow-up of 4.6 years. Of these, 983 (17.2%) had an eGFR under 60 ml/min/1.73 m2 (mean eGFR 49 ml/min/1.73 m2) and 4,729 over 60 ml/min/1.73 m2 (mean 84 ml/min/1.73 m2). In participants with an eGFR under 60 ml/min/1.73 m2 there were 26 primary outcomes in 502 participants on aspirin and 39/481 on placebo (hazard ratio 0.57; 95% confidence interval 0.34-0.94). In participants with an eGFR over 60 ml/min/1.73 m2 there were 90 primary outcomes in 2357 participants on aspirin and 95/2372 on placebo (0.95; 0.71-1.27). With tertiles of eGFR under 70, 70-90, and over 90 ml/min/1.73 m2, risk reductions with aspirin for the primary outcome were larger at lower eGFR levels (0.62; 0.43-0.91) for the lowest tertile, (0.96; 0.62-1.49) for the middle, and (1.30; 0.77-2.18) for the highest tertile. Thus, our findings support aspirin may reduce cardiovascular events in people with moderate to advanced stage CKD.
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