title: Aspirin and renal insufficiency progression in patients with atrial fibrillation and chronic kidney disease.
abstract: BACKGROUND
  In experimental models, thromboxane (Tx)A2reduced renal perfusion and accelerated renal failure. The aim of the study was to investigate the association between the use of aspirin, which inhibits TxA2production, and the incidence of an estimated Glomerular Filtration Rate (eGFR) <60 and <45ml/min/1.73m2in patients with atrial fibrillation (AF) and chronic kidney disease (CKD).
  
  
  METHODS
  Prospective multicentre observational cohort study including 800 anticoagulated AF patients; CKD was defined as an eGFR <90ml/min/1.73m2by CKD-EPI formula; eGFR was measured at baseline and after a median of 28.0months. Urinary 11-dehydro-TxB2, was measured in 401 patients. The incidence of cardiovascular events (CVEs) was also registered.
  
  
  RESULTS
  Baseline eGFR was 65.1ml/min/1.73m2; 147 and 91 patients had incident eGFR<60 and <45ml/min/1.73m2, respectively; 16.5% patients received a concomitant treatment with aspirin 100mg/day. Multivariate logistic regression analysis showed a direct association with incident eGFR<45ml/min/1.73m2for female sex (odds ratio [OR]:1.910, p=0.005) and hypertension (OR: 7.589, p=0.047), while aspirin use was inversely associated (OR: 0.347, p=0.016). Propensity score adjustment confirmed this association (p=0.017). Patients with incident eGFR<45ml/min/1.73m2had higher TxB2, compared to those without (123.0 vs. 90.0ng/mg creatinine, p=0.031); TxB2was inversely associated with incident eGFR<45ml/min/1.73m2(log TxB2OR 2.239, p=0.036). Incident eGFR<45ml/min was associated with an increased rate of CVEs (HR: 2.211, p=0.01).
  
  
  CONCLUSIONS
  Aspirin use was associated with a less decline in eGFR in our cohort of AF patients with CKD. Our findings suggest that TxA2may be implicated in renal function deterioration in AF.
authors: I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
authors: Daniele
authors: D
authors: Pastori
authors: I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
authors: Pasquale
authors: P
authors: Pignatelli
authors: Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
authors: Francesco
authors: F
authors: Perticone
authors: Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
authors: Angela
authors: A
authors: Sciacqua
authors: I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
authors: Roberto
authors: R
authors: Carnevale
authors: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
authors: Alessio
authors: A
authors: Farcomeni
authors: I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
authors: Stefania
authors: S
authors: Basili
authors: First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors: Gino R
authors: GR
authors: Corazza
authors: Department of Medicine and Aging, University of Chieti "G. d'Annunzio" School of Medicine, Chieti, Italy.
authors: Giovanni
authors: G
authors: Davì
authors: Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, England.
authors: Gregory Y H
authors: GYH
authors: Lip
authors: I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy. Electronic address: francesco.violi@uniroma1.it.
authors: Francesco
authors: F
authors: Violi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D016861:Cyclooxygenase Inhibitors; D001241:Aspirin
keywords: Arterial hypertension; Aspirin; Atrial fibrillation; Chronic kidney disease; Thromboxane