Older adults with CKD at increased risk for hemorrhaging
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Key takeaways:
- Chronic kidney disease correlates with an increased risk of major hemorrhage in older adults.
- Risk factors of bleeding include unnecessary aspirin use.
Older adults with chronic kidney disease are at an increased risk for major hemorrhage, according to data published in Kidney International.
“Despite the high prevalence of CKD in older populations, data on the bleeding risk in this population are lacking because current studies, including a Cochrane systematic review, are derived from younger populations or those with advanced kidney disease. This is an important evidence gap, given the intersection of aging populations in many Western countries, the substantial morbidity associated with major bleeding events, and because bleeding events are a major source of health care expenditure,” Suzanne E. Mahady, PhD, from the school of public health and preventive medicine at Monash University in Australia, and colleagues wrote. “Data generated from the Aspirin in Reducing Events in the Elderly (ASPREE) trial provide an unprecedented opportunity to examine bleeding risk in an older, highly characterized population with CKD.”
In a post hoc secondary analysis, researchers examined data of 17,976 patients with CKD who were aged least 70 years from the ASPREE trial to measure the correlation between bleeding in older adults and CKD status.
Patients received 100 mg of enteric-coated aspirin daily or placebo with a median follow-up of 4.5 years. CKD was measured using eGFR or urinary albumin-to-creatinine ratio (UACR).
Researchers conducted Cox proportional hazards regression models to identify the association between major hemorrhage and eGFR or UACR as categorical or continuous variables. Moreover, they performed statistical tests to identify the relationship between aspirin and CKD status, as well as bleeding.
Compared to patients without CKD, patients with CKD experienced an increased risk for major bleeding events (10.4 per 1,000 person-years vs. 6.3 per 1,000 person-years), increased bleeding risk and increased relative risk for albuminuria. Analyses revealed the presence of CKD correlated with a 35% increased risk of bleeding.
Additional risk factors for bleeding in patients with CKD included older age, hypertension, smoking and aspirin use. However, researchers did not identify a statistically significant effect of aspirin on bleeding by CKD status.
“In conclusion, CKD in otherwise healthy older people is associated with elevated risk of major bleeding as albuminuria increases or when eGFR is reduced to [less than] 40 mL/min per 1.73 m2,” Mahady and colleagues wrote. “Given the association of CKD and bleeding in older persons, preemptive strategies to reduce bleeding risk, such as discontinuation of unnecessary aspirin use, smoking cessation and blood pressure control, are warranted.”
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