From the Guidelines
Aspirin should be avoided in CKD stage 4 unless specifically prescribed by a nephrologist or physician familiar with your kidney condition, due to increased bleeding risk and potential for further kidney damage. The use of aspirin in patients with chronic kidney disease (CKD) is a complex issue, and the decision to prescribe it should be made on a case-by-case basis. According to the most recent study 1, the evidence to use aspirin for secondary prevention of recurrent atherosclerotic disease events is moderate at best in persons with CKD, given potential harm with only modest reduction in risk of myocardial infarction.
Some key points to consider when deciding whether to take aspirin in CKD stage 4 include:
- The increased risk of bleeding associated with aspirin use in CKD patients, as noted in the study 1, which found a relative increase in major bleeding and minor bleeding in persons with CKD.
- The potential for aspirin to reduce blood flow to the kidneys and inhibit protective prostaglandins that help maintain kidney function, as mentioned in the example answer.
- The importance of consulting a nephrologist before taking any over-the-counter pain medications, including aspirin, due to the potential for impaired kidney function to affect medication clearance and increase side effects.
- The availability of alternative pain relievers that may be recommended by your doctor based on your specific medical situation and kidney function.
In terms of specific guidance, the study 1 notes that KDIGO has a class C recommendation for oral low-dose aspirin in the secondary prevention of recurrent ischemic cardiovascular events in persons with CKD. However, the use of aspirin in CKD stage 4 should be approached with caution, and patients should consult their nephrologist before taking it. If aspirin is deemed necessary, it should typically be prescribed at the lowest effective dose (usually 81 mg daily) rather than regular-strength formulations, as noted in the example answer.
From the Research
Aspirin Use in CKD 4 Patients
- The use of aspirin in patients with chronic kidney disease (CKD) is a topic of ongoing debate, with some studies suggesting potential benefits and others indicating possible harms 2, 3, 4, 5, 6.
- A study published in the Journal of Thrombosis and Haemostasis found that the antiplatelet effects of aspirin are impaired in patients with moderate to severe CKD, which may increase the risk of ischemic events 2.
- Another study published in PLoS ONE found that low-dose aspirin use was associated with an increased risk of cardiovascular disease and renal progression in patients with CKD 3.
- A more recent study published in Scientific Reports found that low-dose aspirin use was associated with an increased risk of cardiovascular events in patients with CKD and low body weight 4.
- A review published in JAMA emphasized the importance of careful management of CKD, including avoidance of potential nephrotoxins such as nonsteroidal anti-inflammatory drugs, which includes aspirin 5.
- However, a study published in Kidney International found that aspirin may reduce cardiovascular events in people with moderate to advanced stage CKD, particularly those with an estimated glomerular filtration rate (eGFR) under 60 ml/min/1.73 m2 6.
Key Considerations
- The decision to use aspirin in patients with CKD 4 should be individualized, taking into account the patient's overall cardiovascular risk profile and kidney function 2, 3, 4, 5, 6.
- Patients with CKD 4 should be closely monitored for signs of kidney dysfunction and cardiovascular disease, and aspirin therapy should be adjusted accordingly 2, 3, 4, 5, 6.
- Further research is needed to fully understand the effects of aspirin on cardiovascular outcomes in patients with CKD 4 and to determine the optimal treatment strategies for this population 2, 3, 4, 5, 6.