Can Aspirin (acetylsalicylic acid) be taken with impaired renal function, specifically a glomerular filtration rate (GFR) of 58?

From the Guidelines

You can generally take aspirin with a GFR of 58, but it is crucial to exercise caution and consult your healthcare provider, especially if you have other kidney risk factors or are taking medications that affect kidney function. Aspirin is primarily metabolized by the liver and doesn't typically require dose adjustment for this level of kidney function 1. Standard dosing for pain relief is 325-650 mg every 4-6 hours as needed, while low-dose aspirin (81 mg daily) is used for cardiovascular protection. However, aspirin can affect kidney function in some people, especially with long-term use or higher doses, by reducing blood flow to the kidneys and potentially causing fluid retention 1.

Some key considerations include:

• Monitoring for side effects like stomach pain, unusual bleeding, or swelling
• Having your kidney function checked periodically if you use aspirin long-term
• Being aware that renal disease increases the risks of bleeding, which could counterbalance the benefits of aspirin 1
• Considering the guidelines for antiplatelet therapy in patients with chronic kidney disease, which suggest that aspirin may be indicated for secondary prevention but not for primary prevention 1

It is essential to weigh the potential benefits of aspirin against the potential risks, particularly in patients with kidney disease, and to make informed decisions under the guidance of a healthcare provider.

From the Research

Aspirin Use with GFR of 58

• The use of aspirin in patients with a glomerular filtration rate (GFR) of 58 is a topic of interest due to the potential benefits and risks associated with its use in patients with chronic kidney disease (CKD) 2, 3, 4.
• A study published in the Journal of the American College of Cardiology found that aspirin therapy produces greater absolute reduction in major cardiovascular events and mortality in hypertensive patients with CKD than with normal kidney function 2.
• Another study published in the Journal of thrombosis and haemostasis found that the antiplatelet effects of aspirin are associated with impaired renal function, and that patients with CKD have an increased risk of impaired antiplatelet effects of aspirin 3.
• A more recent study published in Kidney international found that aspirin may reduce cardiovascular events in people with moderate to advanced stage CKD, with a greater risk reduction observed at lower eGFR levels 4.
• It is essential to weigh the potential benefits and risks of aspirin use in patients with CKD, considering factors such as the degree of kidney dysfunction, cardiovascular risk, and bleeding risk 2, 3, 4.
• The decision to use aspirin in a patient with a GFR of 58 should be made on an individual basis, taking into account the patient's specific clinical characteristics and medical history 2, 3, 4.

Key Considerations

• The pharmacodynamic response to aspirin varies significantly between individuals, and impaired renal function is associated with an increased risk of impaired antiplatelet effects of aspirin 3.
• Aspirin therapy may produce a greater absolute reduction in major cardiovascular events and mortality in patients with CKD, but the risk of bleeding should also be considered 2, 4.
• Aerobic exercise training has been shown to have a small beneficial effect on estimated glomerular filtration rate and exercise tolerance in patients with CKD stages 3-4, but the impact on aspirin use is unclear 5.
• Aspirin remains a widely prescribed antithrombotic drug, and its use in patients with CKD should be carefully evaluated and monitored 6.