Results from the International Polycap Study-3 (TIPS-3) show that patients with moderate to severe chronic kidney disease (CNS) had a lower risk of cardiovascular outcomes when treated with aspirin compared to placebo. The lower the kidney function, the stronger the effect.
It is well known that patients with CNS have a high risk of cardiovascular disease. Researchers at TIPS-3 investigated whether this risk could be reduced by aspirin use in patients with different baseline values for renal function.
In the trial, they randomized 5,712 patients who had no prior cardiovascular disease to aspirin (75 mg/day) or placebo. Of these, 983 patients (17.2%) had an eGFR < 60 ml/min/1.73 m2 and the remaining 4,729 a higher eGFR. Participants were followed for an average of 4.6 years until the primary endpoint – a composite outcome measure of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death – occurred.
In the subgroup with the lowest renal function (< 60 ml/min/1.73 m2), the primary endpoint occurred in 26 of 502 participants on aspirin and 39 of 481 on placebo (HR: 0.57; 95% CI 0.34-0.94). In participants with an eGFR of 60 ml/min/1.73 m2 or greater, the primary endpoint occurred in 90 of 2,357 participants on aspirin and 95 of 2,372 participants on placebo (HR: 0.95; 95% CI 0.71-1.27). Also when the analyzes were performed in tertiles for eGFR (< 70, 70-90 en > 90 ml/min/1,73 m2), risk reduction for the primary endpoint with aspirin appeared greater with lower renal function, with HRs of 0.62 (95% CI 0.43-0.91) for the lowest, 0.96 (0.62-1, 49) for the middle and 1.30 (0.77-2.18) for the highest tertile.
Bron:
Mann JFE, Joseph P, Gao P, et al. Effects of aspirin on cardiovascular outcomes in patients with chronic kidney disease. Kidney Int 2023;103:403-10.