Aspirin and cardiovascular primary prevention in non-endstage chronic kidney disease: A meta-analysis.

BACKGROUND AND AIMS: Chronic kidney disease is a strong independent predictor of cardiovascular disease. No published meta-analyses on the use of aspirin for the primary prevention of cardiovascular disease in chronic kidney disease exist. We therefore performed a systematic review and meta-analysis of this subject. METHODS: We used a pre-defined and registered protocol (PROSPERO identification CRD42014008860). We searched Medline and Embase between 1996 and July 2015. Inclusion criteria were adult subjects with non-endstage chronic kidney disease (CKD) and no history of cardiovascular disease. The co-primary outcomes were major cardiovascular events and all-cause mortality. Secondary outcomes included bleeding-related events. We used a random effects model to pool data. RESULTS: Three trials were identified and two of these provided previously unpublished data. The studies included 4468 participants and 16,740 person-years of follow-up. There were no statistically significant reductions in the risk of major cardiovascular events (RR 0.92, 95% CI 0.49 to 1.73, p = 0.79, I(2) 71%) or mortality (RR 0.74, 95% CI 0.55 to 1.00, p = 0.05, I(2) 0%) with aspirin compared to the control group. Major bleeding events were increased with aspirin though (RR 1.98, 95% CI 1.11 to 3.52, p = 0.02, I(2) 0%). CONCLUSIONS: There is no clear benefit of aspirin for the primary prevention of cardiovascular events in CKD and no statistically significant reduction in mortality. Aspirin is likely to increase the risk of major bleeding events. Currently, insufficient randomised control trial data exists to recommend universal use or avoidance of aspirin for primary prevention of cardiovascular events in CKD.