Aspirin for primary prevention of CVD in CKD: where do we stand?

CHRONIC KIDNEY DISEASE IS A POWERFUL AND POTENTIALLY MODIFIABLE RISK FACTOR FOR CARDIOVASCULAR DISEASE

Chronic kidney disease (CKD) is defined as any abnormality of kidney function or structure with implications for health that is present for more than 3 months. It is classified according to the estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (ACR). The presence of an eGFR <60 mL/min/1.73 m² or an ACR ≥3 mg/mmol for >90 days is diagnostic of CKD.

CKD is common. Data from the 2016 Health Survey of England reveal that 15% of people aged ≥35 years have CKD (stage 1 to 5), with 7% in CKD stages 3 to 5.¹ An important minority of people with CKD will progress to end-stage renal disease and require renal replacement therapy, but the greatest significance of CKD is as a powerful and potentially modifiable risk factor for cardiovascular disease (CVD). Large-scale robust epidemiological data indicate that the risks of both all-cause mortality and cardiovascular (CV) mortality in the general population increase with eGFR <60 mL/min/1.73 m² or an ACR ≥1 mg/mmol. The risks are graded: compared to eGFR 95 ml/min/1.73 m², hazard ratios for CV mortality at eGFR 60, 45, and 15 ml/min/1.73 m² are approximately 1.5, 2, and 3 respectively; a similar pattern is seen with rising urine ACR. eGFR and ACR are multiplicatively associated with mortality risk with no evidence of interaction.²

The pattern of vascular events in people with CKD varies according to disease severity. In less severe renal disease, atherothrombotic events dominate. With severe impairment of eGFR and in particular in those receiving renal replacement …