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Updated: Jun 7, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Risk Factors for Major Bleeding among Patients with Chronic Kidney Disease Treated with Acetylsalicylic Acid
Gil Schwartz Yoskovitz1, Meytal Schwartz Yoskovitz1, Hadar Haim-Pinhas1,2
1Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Insights
Older age is the primary risk factor for major bleeding events in chronic kidney disease (CKD) patients taking acetylsalicylic acid (ASA) for cardiovascular disease (CVD) prevention. This highlights the need for personalized risk assessment in CKD patients on ASA therapy.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Patients with chronic kidney disease (CKD) face elevated risks of both thrombotic and bleeding complications.
- Acetylsalicylic acid (ASA) is widely used for cardiovascular disease (CVD) prevention but carries an inherent risk of bleeding.
- Identifying CKD patients susceptible to bleeding during ASA therapy is crucial for safe and effective treatment.
Purpose of the Study:
- To characterize chronic kidney disease (CKD) patients at higher risk of experiencing major bleeding events while undergoing acetylsalicylic acid (ASA) therapy for primary cardiovascular disease (CVD) prevention.
Main Methods:
- Retrospective analysis of non-dialysis-dependent CKD patients treated with ASA for ≥3 months.
- Exclusion of patients on concurrent anticoagulants or antiplatelets.
- Comparison of patients with major bleeding events (bleeding group) versus controls, with data collected from January 2014 to December 2018.
Main Results:
- Out of 900 CKD patients, 9.1% experienced major bleeding events during follow-up.
- Gastrointestinal bleeding was the most frequent type (63.4% of major events).
- Older age was significantly associated with major bleeding events (76.5 ± 10 years in bleeding group vs. 74 ± 10.3 years in control group; p = 0.038).
- Multivariate analysis identified age as the most significant predictor of major bleeding (OR: 1.029, 95% CI: 1.004-1.056).
Conclusions:
- Given the debated efficacy of ASA for primary CVD prevention in CKD patients, identifying bleeding risks is vital.
- Age, CKD stage, and cardiovascular risk are key determinants for the safe and effective use of ASA in this population.
- Tailored medical approaches are necessary for optimizing ASA therapy in CKD patients.
Introduction:
Individuals with chronic kidney disease (CKD) are at increased risk of 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 of 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) versus all others (control group) were compared. Additional outcomes included first documented nonfatal 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 of 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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