Aspirin Applications in Chronic Kidney Disease and Cardiovascular Health

Aspirin has long been established as an antiplatelet agent for secondary prevention of atherothrombotic events, yet its role in chronic kidney disease (CKD) is complex. Patients with CKD face both heightened risk of cardiovascular disease (CVD) and altered haemostasis due to uraemic platelet dysfunction and endothelial injury. Low-dose aspirin may attenuate thrombotic risk, but an increased propensity to bleeding and potential impacts on renal progression must be weighed carefully. Recent clinical investigations have explored whether aspirin can deliver net cardiovascular benefit in CKD populations without accelerating loss of kidney function. Results to date highlight a narrow therapeutic window: the drug may reduce certain vascular endpoints in patients with preserved weight and moderate impairment, but may also exacerbate renal decline or fail to lower overall mortality when used for primary CVD prevention. Contemporary research seeks to define which subgroups derive benefit, how dosage interacts with body composition, and how to balance competing risks of ischaemia and bleeding in CKD.

Research from Nature Portfolio

Recent cohort analyses in Asian CKD registries have demonstrated that chronic low-dose aspirin use was associated with an increased incidence of major cardiovascular events, particularly among individuals in the lowest quartile of body weight. In these studies, propensity-matched aspirin users experienced higher rates of myocardial infarction and stroke without significant reductions in all-cause mortality or renal outcomes, suggesting that weight-tailored dosing may be critical. A larger retrospective investigation of primary prevention in older CKD patients found no significant differences in cardiovascular event rates or bleeding complications between aspirin users and non-users after adjustment for comorbidities. These findings underscore the absence of clear protective effects in primary prophylaxis and raise caution about routine aspirin prescription in unselected CKD cohorts.

Aspirin Applications in Chronic Kidney Disease and Cardiovascular Health publication trend

The graph below shows the total number of articles in aspirin applications in chronic kidney disease and cardiovascular health across all publications each year (not limited to Nature Index journals).

Technical terms

Estimated glomerular filtration rate (eGFR): A calculated index of kidney function reflecting filtration capacity, usually based on serum creatinine.

Propensity score matching: A statistical method that pairs treated and untreated subjects with similar covariate profiles to reduce confounding in observational studies.

Major cardiovascular event: A composite endpoint typically including non-fatal myocardial infarction, non-fatal stroke and cardiovascular death.

Primary prevention: Strategies aimed at preventing the first occurrence of disease in at-risk individuals.

Secondary prevention: Measures taken to prevent recurrence or complications after an initial disease event.

References

1. Low-Dose Aspirin for Prevention of Cardiovascular Disease in Patients with Chronic Kidney Disease. PLOS ONE (2014).
2. Low-dose aspirin was associated with an increased risk of cardiovascular events in patients with chronic kidney disease and low bodyweight: results from KNOW-CKD study. Scientific Reports (2021).
3. Effect of aspirin on primary prevention of cardiovascular disease and mortality among patients with chronic kidney disease. Scientific Reports (2022).
4. Hazardous Effect of Low-Dose Aspirin in Patients with Predialysis Advanced Chronic Kidney Disease Assessed by Machine Learning Method Feature Selection. Healthcare (2021).
5. Association of long-term aspirin use with kidney disease progression. Frontiers in Medicine (2023).