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Subgroup analysis of the ASPirin in reducing events in the elderly randomized clinical trial suggests aspirin did not improve outcomes in older adults with chronic kidney disease

Subgroup analysis of the ASPirin in reducing events in the elderly randomized clinical trial suggests aspirin did not improve outcomes in older adults with chronic kidney disease
Subgroup analysis of the ASPirin in reducing events in the elderly randomized clinical trial suggests aspirin did not improve outcomes in older adults with chronic kidney disease

The role of aspirin for primary prevention in older adults with chronic kidney disease (CKD) is unclear. Therefore, post hoc analysis of the randomized controlled trial ASPirin in Reducing Events in the Elderly (ASPREE) was undertaken comparing 100 mg of enteric-coated aspirin daily against matching placebo. Participants were community dwelling adults aged 70 years and older in Australia, 65 years and older in the United States, all free of a history of dementia or cardiovascular disease and of any disease expected to lead to death within five years. CKD was defined as present at baseline if either eGFR under 60mL/min/1.73m2 or urine albumin to creatinine ratio 3 mg/mmol or more. In 4758 participants with and 13004 without CKD, the rates of a composite endpoint (dementia, persistent physical disability or death), major adverse cardiovascular events and clinically significant bleeding in the CKD participants were almost double those without CKD. Aspirin's effects as estimated by hazard ratios were generally similar between CKD and non-CKD groups for dementia, persistent physical disability or death, major adverse cardiovascular events and clinically significant bleeding. Thus, in our analysis aspirin did not improve outcomes in older people while increasing the risk of bleeding, with mostly consistent effects in participants with and without CKD.

aspirin, bleeding, cardiovascular events, chronic kidney disease, elderly, randomized clinical trial
0085-2538
466-474
Wolfe, Rory
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Wetmore, James B.
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Woods, Robyn L.
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McNeil, John J.
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Gallagher, Hugh
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Roderick, Paul
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Walker, Rowan
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Nelson, Mark R.
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Reid, Christopher M.
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Shah, Raj C.
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Ernst, Michael E.
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Lockery, Jessica E.
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Tonkin, Andrew M.
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Abhayaratna, Walter P.
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Gibbs, Peter
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Wood, Erica M.
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Mahady, Suzanne E.
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Williamson, Jeff D.
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Donnan, Geoffrey A.
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Cloud, Geoffrey C.
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Murray, Anne M.
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Polkinghorne, Kevan R.
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Wolfe, Rory
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Wetmore, James B.
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Woods, Robyn L.
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McNeil, John J.
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Gallagher, Hugh
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Roderick, Paul
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Walker, Rowan
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Nelson, Mark R.
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Reid, Christopher M.
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Shah, Raj C.
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Ernst, Michael E.
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Lockery, Jessica E.
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Tonkin, Andrew M.
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Abhayaratna, Walter P.
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Gibbs, Peter
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Wood, Erica M.
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Mahady, Suzanne E.
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Williamson, Jeff D.
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Donnan, Geoffrey A.
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Cloud, Geoffrey C.
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Murray, Anne M.
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Polkinghorne, Kevan R.
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Wolfe, Rory, Wetmore, James B., Woods, Robyn L., McNeil, John J., Gallagher, Hugh, Roderick, Paul, Walker, Rowan, Nelson, Mark R., Reid, Christopher M., Shah, Raj C., Ernst, Michael E., Lockery, Jessica E., Tonkin, Andrew M., Abhayaratna, Walter P., Gibbs, Peter, Wood, Erica M., Mahady, Suzanne E., Williamson, Jeff D., Donnan, Geoffrey A., Cloud, Geoffrey C., Murray, Anne M. and Polkinghorne, Kevan R. (2021) Subgroup analysis of the ASPirin in reducing events in the elderly randomized clinical trial suggests aspirin did not improve outcomes in older adults with chronic kidney disease. Kidney International, 99 (2), 466-474. (doi:10.1016/j.kint.2020.08.011).

Record type: Article

Abstract

The role of aspirin for primary prevention in older adults with chronic kidney disease (CKD) is unclear. Therefore, post hoc analysis of the randomized controlled trial ASPirin in Reducing Events in the Elderly (ASPREE) was undertaken comparing 100 mg of enteric-coated aspirin daily against matching placebo. Participants were community dwelling adults aged 70 years and older in Australia, 65 years and older in the United States, all free of a history of dementia or cardiovascular disease and of any disease expected to lead to death within five years. CKD was defined as present at baseline if either eGFR under 60mL/min/1.73m2 or urine albumin to creatinine ratio 3 mg/mmol or more. In 4758 participants with and 13004 without CKD, the rates of a composite endpoint (dementia, persistent physical disability or death), major adverse cardiovascular events and clinically significant bleeding in the CKD participants were almost double those without CKD. Aspirin's effects as estimated by hazard ratios were generally similar between CKD and non-CKD groups for dementia, persistent physical disability or death, major adverse cardiovascular events and clinically significant bleeding. Thus, in our analysis aspirin did not improve outcomes in older people while increasing the risk of bleeding, with mostly consistent effects in participants with and without CKD.

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More information

Accepted/In Press date: 13 August 2020
e-pub ahead of print date: 10 September 2020
Published date: February 2021
Keywords: aspirin, bleeding, cardiovascular events, chronic kidney disease, elderly, randomized clinical trial

Identifiers

Local EPrints ID: 447955
URI: http://eprints.soton.ac.uk/id/eprint/447955
ISSN: 0085-2538
PURE UUID: 764b6f32-b6e6-48d8-a15c-32be162f5b93
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 26 Mar 2021 17:33
Last modified: 26 Nov 2021 02:37

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Contributors

Author: Rory Wolfe
Author: James B. Wetmore
Author: Robyn L. Woods
Author: John J. McNeil
Author: Hugh Gallagher
Author: Paul Roderick ORCID iD
Author: Rowan Walker
Author: Mark R. Nelson
Author: Christopher M. Reid
Author: Raj C. Shah
Author: Michael E. Ernst
Author: Jessica E. Lockery
Author: Andrew M. Tonkin
Author: Walter P. Abhayaratna
Author: Peter Gibbs
Author: Erica M. Wood
Author: Suzanne E. Mahady
Author: Jeff D. Williamson
Author: Geoffrey A. Donnan
Author: Geoffrey C. Cloud
Author: Anne M. Murray
Author: Kevan R. Polkinghorne

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