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Updated: Aug 2, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Association Between CKD and Major Hemorrhage in Older Persons: Data From the Aspirin in Reducing Events in the
Suzanne E Mahady1,2, Galina Polekhina1, Robyn L Woods1
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Insights
Older adults with chronic kidney disease (CKD) face a higher risk of major bleeding events. Managing modifiable risk factors like aspirin use and blood pressure is crucial for this population.
Area of Science:
- Nephrology
- Geriatrics
- Cardiovascular Medicine
Background:
- Limited data exist on the association between chronic kidney disease (CKD) and major hemorrhage in the elderly population.
- CKD affects kidney function, potentially increasing bleeding risks.
Purpose of the Study:
- To investigate the association between CKD and major hemorrhage in adults aged 70 years and older.
- To identify risk factors for bleeding in this demographic.
Main Methods:
- Utilized data from a double-blind randomized controlled trial of aspirin in individuals aged ≥ 70 years.
- Defined CKD using estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² and/or urinary albumin-to-creatinine ratio (UACR) ≥ 3 mg/mmol.
- Compared bleeding rates and performed multivariable analyses, exploring aspirin's effect modification.
Main Results:
- Of 17,976 participants with recorded CKD status, 27.5% had CKD.
- CKD was associated with increased major bleeding events (10.4/1000 person-years vs. 6.3/1000 person-years).
- Adjusted analyses revealed CKD independently increased bleeding risk by 35% (HR 1.37; 95% CI: 1.15, 1.62).
Conclusions:
- Chronic kidney disease is an independent risk factor for major hemorrhage in older adults.
- Increased awareness and management of modifiable risk factors (e.g., aspirin use, hypertension, smoking) are warranted.
- No differential effect of aspirin on bleeding risk was observed based on CKD status.
Introduction:
Data on the association between chronic kidney disease (CKD) and major hemorrhage in older adults are lacking.
Methods:
We used data from a double-blind randomized controlled trial of aspirin in persons aged ≥ 70 years with prospective capture of bleeding events, including hemorrhagic stroke and clinically significant bleeding. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m2 and/or urinary albumin-to-creatinine ratio (UACR) ≥ 3 mg/mmol (26.6 mg/g). We compared bleeding rates in those with and without CKD, undertook multivariable analyses, and explored effect modification with aspirin.
Results:
Of 19,114 participants, 17,976 (94.0%) had CKD status recorded, of whom 4952 (27.5%) had CKD. Participants with CKD had an increased rate of major bleeding events compared with those without CKD (10.4/1000 vs. 6.3/1000 person-years [py], respectively) and increased bleeding risk (risk ratio [RR] 1.60; 95% confidence interval [CI]: 1.40, 1.90 for eGFR < 60 ml/min per 1.73 m2) and RR (2.10; 95% CI: 1.70, 2.50) for albuminuria. In adjusted analyses, CKD was associated with a 35% increased risk of bleeding (hazard ratio [HR] 1.37; 95% CI: 1.15, 1.62; P < 0.001). Other risk factors were older age, hypertension, smoking, and aspirin use. There was no differential effect of aspirin on bleeding by CKD status (test of interaction P = 0.65).
Conclusion:
CKD is independently associated with an increased risk of major hemorrhage in older adults. Increased awareness of modifiable risk factors such as discontinuation of unnecessary aspirin, blood pressure control, and smoking cessation in this group is warranted.
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