Is long-term use of low-dose Aspirin (acetylsalicylic acid) safe in patients with Impaired renal function due to a solitary kidney (uninephria)?

From the Guidelines

Taking low-dose aspirin long-term with one kidney requires caution and medical supervision, and the decision to use it should be based on individual risk assessment, considering the potential benefits of cardiovascular protection against the risks of bleeding and kidney function impairment, as suggested by studies such as 1 and 1. When considering the use of low-dose aspirin in individuals with a single kidney, it's crucial to weigh the potential benefits against the risks. The primary concern is the balance between the cardiovascular protective effects of aspirin and the potential for increased bleeding risk and adverse effects on kidney function.

• Key factors influencing this decision include the individual's overall kidney function, age, blood pressure, and whether they are taking other medications that could affect the kidneys.
• Studies have shown that low-dose aspirin can reduce the risk of cardiovascular events in certain populations, but the evidence in individuals with chronic kidney disease (CKD) or a single kidney is less clear, with some studies suggesting a potential increase in bleeding risk, as noted in 1.
• The 2013 KDIGO guidelines, referenced in 1, suggest that adults with CKD who are at risk for atherosclerotic events be offered treatment with anti-platelet agents unless there is an increased bleeding risk that needs to be balanced against the possible cardiovascular benefits.
• Regular monitoring of kidney function through blood tests is essential for individuals on long-term aspirin therapy, especially those with a single kidney, to promptly identify any adverse effects on kidney function.
• The optimal dose of aspirin for individuals with a single kidney is not well established, but doses of 75-100 mg/day have been effective in trials of patients with CKD, as discussed in 1.
• Ultimately, the decision to prescribe low-dose aspirin to an individual with one kidney should be made by a healthcare provider, taking into account the person's complete medical profile and the potential risks and benefits, as the evidence from studies like 1, 1, and 1 suggests.

From the Research

Safety of Low-Dose Aspirin with One Kidney

• The safety of taking low-dose aspirin long-term with one kidney is a complex issue, with various studies yielding different results 2, 3, 4, 5, 6.
• 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 chronic kidney disease (CKD) than with normal kidney function 2.
• However, another study published in the Journal of thrombosis and haemostasis found that the antiplatelet effects of aspirin are associated with impaired renal function, and 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 4.
• In contrast, a systematic review and meta-analysis published in International urology and nephrology found that aspirin had no significant prevention effect on cardiovascular events among CKD patients, and no statistically significant reduction in risk of cardiovascular or all-cause mortality, with a significant increased risk of minor bleeding and renal events 5.
• Another systematic review and meta-analysis published in Current vascular pharmacology found that aspirin did not prevent CV events, with a significantly increased risk of minor bleeding and renal events, but had a statistically significant reduction in the risk of CV mortality 6.

Key Findings

• Aspirin may reduce cardiovascular events in people with moderate to advanced stage CKD 4.
• Aspirin has no significant prevention effect on cardiovascular events among CKD patients, and no statistically significant reduction in risk of cardiovascular or all-cause mortality, with a significant increased risk of minor bleeding and renal events 5.
• Aspirin did not prevent CV events, with a significantly increased risk of minor bleeding and renal events, but had a statistically significant reduction in the risk of CV mortality 6.

Considerations

• The decision to take low-dose aspirin long-term with one kidney should be made on an individual basis, taking into account the patient's specific medical history and risk factors 2, 3, 4, 5, 6.
• Patients with CKD should be closely monitored for signs of bleeding and renal events while taking aspirin 5, 6.