title: Different impact of aspirin on renal progression in patients with predialysis advanced chronic kidney disease with or without previous stroke.
abstract: BACKGROUND
  The benefit of reducing the risk of stroke against increasing the risk of renal progression associated with antiplatelet therapy in patients with advanced chronic kidney disease (CKD) is controversial.
  
  
  METHODS
  We enrolled 1301 adult patients with advanced CKD treated with erythropoiesis stimulating agents from January 1, 2002 to June 30, 2009 from the 2005 Longitudinal Health Insurance Database in Taiwan. All of the patients were followed until the development of the primary or secondary endpoints, or the end of the study (December 31, 2011). The primary endpoint was the development of ischemic stroke, and the secondary endpoints included hospitalization for bleeding events, cardiovascular mortality, all-cause mortality, and renal failure. The adjusted cumulative probability of events was calculated using multivariate Cox proportional regression analysis.
  
  
  RESULTS
  Adjusted survival curves showed that the usage of aspirin was not associated with ischemic stroke, hospitalization for bleeding events, cardiovascular mortality or all-cause mortality, however, it was significantly associated with renal failure. In subgroup analysis, aspirin use was associated with renal failure in the patients with no history of stroke (HR, 1.41; 95% CI, 1.14-1.73), and there was a borderline interaction between previous stroke and the use of aspirin on renal failure (interaction p=0.0565).
  
  
  CONCLUSIONS
  There was no significant benefit in preventing ischemic stroke in the patients with advanced CKD who received aspirin therapy. Furthermore, the use of aspirin was associated with the risk of renal failure in the patients with advanced CKD without previous stroke.
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Nephrology, Department of Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan.
authors.forename: Kuang-Chih
authors.initials: KC
authors.lastname: Hsiao
authors.affiliation: Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan.
authors.forename: Jing-Yang
authors.initials: JY
authors.lastname: Huang
authors.affiliation: Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan.
authors.forename: Chun-Te
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Nephrology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Tung-Wei
authors.initials: TW
authors.lastname: Hung
authors.affiliation: Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan; Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan. Electronic address: liawyp@csmu.edu.tw.
authors.forename: Yung-Po
authors.initials: YP
authors.lastname: Liaw
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Nephrology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan. Electronic address: chrcsmu@gmail.com.
authors.forename: Horng-Rong
authors.initials: HR
authors.lastname: Chang
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000150:complications*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000150:complications* / Q000517:prevention & control; D013624:Taiwan
chemical_list: D006397:Hematinics; D001241:Aspirin
keywords: Advanced chronic kidney disease; Aspirin; Ischemic stroke; Renal failure