Association Between CKD and Major Hemorrhage in Older Persons: Data From the Aspirin in Reducing Events in the Elderly Randomized Trial.

Autor: Mahady SE; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.; Department of Gastroenterology, Melbourne Health, Parkville, Victoria, Australia., Polekhina G; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Woods RL; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Wolfe R; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Wetmore JB; Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota, USA.; Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA., Margolis KL; HealthPartners Institute, Minneapolis, Minnesota, USA., Wood EM; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.; Department of Hematology, Monash Health, Melbourne, Victoria, Australia., Cloud GC; Department of Neurology, Alfred Health, Melbourne, Victoria.; Australia Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia., Murray AM; Berman Center for Outcomes and Clinical Research, Hennepin HealthCare Research Institute, Minneapolis, Minnesota, USA.; Division of Geriatrics, Department of Medicine University of Minnesota, Minneapolis, Minnesota, USA., Polkinghorne KR; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.; Department of Nephrology, Monash Medical Center, Monash Health, Melbourne, Victoria, Australia.; Department of Medicine, Monash University, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: Kidney international reports [Kidney Int Rep] 2023 Jan 19; Vol. 8 (4), pp. 737-745. Date of Electronic Publication: 2023 Jan 19 (Print Publication: 2023).
DOI: 10.1016/j.ekir.2023.01.012
Abstrakt: Introduction: Data on the association between chronic kidney disease (CKD) and major hemorrhage in older adults are lacking.
Methods: We used data from a double-blind randomized controlled trial of aspirin in persons aged ≥ 70 years with prospective capture of bleeding events, including hemorrhagic stroke and clinically significant bleeding. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m 2 and/or urinary albumin-to-creatinine ratio (UACR) ≥ 3 mg/mmol (26.6 mg/g). We compared bleeding rates in those with and without CKD, undertook multivariable analyses, and explored effect modification with aspirin.
Results: Of 19,114 participants, 17,976 (94.0%) had CKD status recorded, of whom 4952 (27.5%) had CKD. Participants with CKD had an increased rate of major bleeding events compared with those without CKD (10.4/1000 vs. 6.3/1000 person-years [py], respectively) and increased bleeding risk (risk ratio [RR] 1.60; 95% confidence interval [CI]: 1.40, 1.90 for eGFR < 60 ml/min per 1.73 m 2 ) and RR (2.10; 95% CI: 1.70, 2.50) for albuminuria. In adjusted analyses, CKD was associated with a 35% increased risk of bleeding (hazard ratio [HR] 1.37; 95% CI: 1.15, 1.62; P  < 0.001). Other risk factors were older age, hypertension, smoking, and aspirin use. There was no differential effect of aspirin on bleeding by CKD status (test of interaction P  = 0.65).
Conclusion: CKD is independently associated with an increased risk of major hemorrhage in older adults. Increased awareness of modifiable risk factors such as discontinuation of unnecessary aspirin, blood pressure control, and smoking cessation in this group is warranted.
(© 2023 International Society of Nephrology. Published by Elsevier Inc.)
Databáze: MEDLINE
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