title: Evidence for preoperative aspirin improving major outcomes in patients with chronic kidney disease undergoing cardiac surgery: a cohort study.
abstract: BACKGROUND
  Effects of aspirin on patients with chronic kidney disease (CKD) remains unclear. This study aimed to examine the effect of preoperative aspirin use on postoperative renal function and 30-day mortality in patients with CKD undergoing cardiac surgery.
  
  
  METHODS
  A retrospective cohort study was performed on consecutive patients (n = 5175) receiving cardiac surgery in 2 tertiary hospitals. Of all patients, 3585 met the inclusion criteria and underwent the analysis to determine the association of preoperative aspirin with incidence of acute kidney injury (AKI) and death based on estimated glomerular filtration rate (eGFR).
  
  
  RESULTS
  Of 3585 patients, 31.5% had CKD (eGFR < 60 mL/min/1.73 m2) at baseline and 27.6% had AKI postoperatively. The baseline eGFR had a nonlinear relationship with the incidence and stages of AKI. As eGFR decreased to 15 to 30 from more than or equal to 90 mL/min/1.73 m2, AKI and 30-day mortality increased to 50.5% from 23.5% and to 11.9% from 2.6%, respectively (P < 0.001). However, preoperative aspirin use was associated with a significant decrease in postoperative AKI and 30-day mortality in patients with CKD undergoing cardiac surgery, in particular, the survival benefit associated with aspirin was greater in patients with CKD (vs normal kidney function): 30-day mortality was reduced by 23.3%, 58.2%, or 70.0% for patients with baseline eGFR more than or equal to 90, 30 to 59, or 15 to 30 mL/min/1.73 m2, respectively (P trend < 0.001).
  
  
  CONCLUSIONS
  For patients with CKD undergoing cardiac surgery, preoperative aspirin therapy was associated with renal protection and mortality decline. The magnitude of the survival benefit was greater in patients with CKD than normal kidney function.
authors.affiliation: *Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA; †Department of Anesthesiology, Tangdu Hospital, The Fourth Military Medical University, Xian, P. R. China; ‡Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, CA; §Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, Sacramento, CA; ¶Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA; ‖Jefferson Medical College, Philadelphia, PA; and **Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Linong
authors.initials: L
authors.lastname: Yao
authors.forename: Nilas
authors.initials: N
authors.lastname: Young
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Li
authors.forename: Will
authors.initials: W
authors.lastname: Sun
authors.forename: Jordan
authors.initials: J
authors.lastname: Goldhammer
authors.forename: Lei
authors.initials: L
authors.lastname: Tao
authors.forename: Jianbin
authors.initials: J
authors.lastname: He
authors.forename: James
authors.initials: J
authors.lastname: Diehl
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Sun
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D001241:Aspirin / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011300:Preoperative Care; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin