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Updated: May 5, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Real-World Antiplatelet Use and Clinical Outcomes in Patients with Advanced Chronic Kidney Disease Following Acute
Lama Alfehaid1,2,3, Eman Alzahrani2, Amani Alsubaie1
1Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh 11481, Saudi Arabia.
Insights
Patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) face high risks of death, recurrent heart attacks, and bleeding after acute coronary syndrome (ACS). Real-world data show a significant burden of these adverse events in this understudied population.
Area of Science:
- Cardiology
- Nephrology
- Clinical Pharmacology
Background:
- Patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) have high risks of ischemic and bleeding events post-acute coronary syndrome (ACS).
- This population is underrepresented in clinical trials of antiplatelet therapy, limiting real-world data on treatment patterns and outcomes.
Purpose of the Study:
- To describe real-world antiplatelet use in patients with advanced CKD or ESRD following ACS.
- To evaluate 12-month clinical outcomes, including mortality, recurrent ischemic events, and bleeding complications.
Main Methods:
- Retrospective, single-center cohort study of 222 adult patients with advanced CKD (stage 4-5) or dialysis-dependent ESRD hospitalized with ACS.
- Data collected on baseline characteristics, revascularization, and 12-month outcomes (mortality, ischemic events, TIMI bleeding criteria).
- Descriptive analyses were performed.
Main Results:
- Clopidogrel was used in 96% of patients; ticagrelor in 4%.
- The cohort was elderly, comorbid, and largely dialysis-dependent.
- At 12 months, approximately one-third experienced all-cause mortality, with frequent recurrent ischemic and bleeding events, particularly in dialysis-dependent individuals.
Conclusions:
- Patients with advanced CKD/ESRD post-ACS face a substantial burden of mortality, ischemic events, and bleeding, indicating a narrow therapeutic window.
- Findings highlight the need for individualized antiplatelet strategies and prospective studies in this high-risk group.
Abstract:
Background: Patients with advanced chronic kidney disease (CKD) experience disproportionately high ischemic and bleeding risks following acute coronary syndrome (ACS), yet remain markedly underrepresented in randomized trials of antiplatelet therapy. Consequently, real-world data describing antiplatelet prescribing patterns and clinical outcomes in this population are limited. Objectives: To describe real-world antiplatelet use and 12-month clinical outcomes in patients with advanced CKD and end-stage renal disease (ESRD) following ACS. Methods: We conducted a single-center, retrospective cohort study including adults with advanced CKD (stage 4-5) or dialysis-dependent ESRD hospitalized with ACS and discharged on dual antiplatelet therapy. Baseline characteristics, revascularization strategies, and clinical outcomes were collected. Outcomes of interest included all-cause mortality, recurrent ischemic events (recurrent myocardial infarction, stroke or transient ischemic attack, or repeat revascularization), and bleeding events defined by Thrombolysis in Myocardial Infarction (TIMI) criteria over 12 months. All analyses were descriptive in nature. Results: A total of 222 patients were included; clopidogrel was prescribed in 96.0% of patients and ticagrelor in 4.0%. The cohort was elderly, highly comorbid, and predominantly dialysis-dependent. At 12 months, all-cause mortality occurred in approximately one-third of patients, recurrent ischemic events were frequent, and bleeding complications were common. Most bleeding events occurred in dialysis-dependent individuals. Outcomes among ticagrelor-treated patients are reported descriptively only due to the very small sample size. Conclusions: In this real-world cohort of patients with advanced CKD and ESRD following ACS, a substantial burden of mortality, recurrent ischemic events, and bleeding complications was observed, underscoring the narrow therapeutic window in this high-risk population. These findings are descriptive and hypothesis-generating, supporting the need for individualized antiplatelet strategies and prospective studies specifically enrolling patients with advanced CKD.
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