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Renal & Urology News 3
American Society of Nephrology’s Kidney Week 2021
Long-Term Aspirin Use Associated With Lower CKD Progression Risk Beneficial effect observed in patients taking the drug for at least 90 days
AKI Increases Readmission, Mortality Risk ACUTE KIDNEY injury (AKI) is an inde-
BY JODY A. CHARNOW LONG-TERM ASPIRIN (ASA) use may be associated with slower deterioration of renal function and decreased risk for death among patients with chronic kidney disease (CKD), according to new study findings. In a study of 856 US veterans with nondialysis CKD, a team led by Csaba P. Kovesdy, MD, of the University of Tennessee Health Science Center in Memphis, examined the association of long-term ASA use (90 days or more) with mortality and a combined renal endpoint of dialysis initiation or a 40% or greater decline in estimated glomerular filtration rate (eGFR). The study population consisted of 653 patients on long-term ASA therapy and 203 ASA nonusers (controls). The groups had mean ages of 68.1 years and 64.2 years, respectively. Of the 653 ASA patients, 7.8% did not receive low-dose ASA (less than 200 mg per day). Over a median follow-up period of 4.8 years, 315 patients (36.7%) reached
Long-term aspirin use may have renoprotective effects, a recent study found.
the combined renal endpoint (236 in the ASA group and 79 in the control arm) and 373 patients (43.5%) died (277 in the ASA group and 96 in the control arm). In a fully adjusted model, patients in the ASA group had a significant 45% lower risk for the renal endpoint and
47% lower risk for death compared with nonusers, Dr Kovesdy and colleagues reported. The investigators adjusted for demographics, body mass index, smoking status, comorbidities, steroid use, baseline eGFR, proteinuria, medication adherence, and other potential confounders. “Microinflammation may be a mechanism contributing to adverse outcomes in patients with CKD,” Dr Kovesdy told Renal & Urology News. “Low-dose ASA is usually used as an antiplatelet agent for cardiovascular indications, but may also have beneficial effects by reducing microinflammation. We found an association between longterm ASA and lower risk of a composite renal outcome and mortality in a single center cohort of patients with CKD. These results will have to be replicated in larger and more diverse cohorts and potentially in future clinical trials, before we can recommend ASA for renoprotection.” ■
pendent risk factor for rehospitalization and death both in the short- and long-term, investigators reported. Ivonne H. Schulman, MD, program director in the Division of Kidney, Urologic, and Hematologic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and colleagues compared 594,509 patients hospitalized with AKI and 594,509 propensity-score matched patients hospitalized for other causes from the 2007-2020 Optum Clinformatics database. AKI was significantly associated with a 77% adjusted increased rate of any hospital readmission within 90 days of initial discharge compared with no AKI, the investigators reported. AKI was also significantly associated with a 1.6-, 3.1-, 3.2-, and 7.9-fold increased risk for pneumonia, sepsis, heart failure, and end-stage kidney disease, respectively, within 90 days of discharge.
© GRACE CARY / GETTY IMAGES
At 1 year, the cumulative incidence
Intensive BP Control May Increase Death Risk
of all-cause rehospitalization was
INTENSIVE BLOOD pressure control targeting a systolic blood pressure (SBP) level of less than 120 mm Hg may increase mortality risk among older veterans, investigators reported. Investigators created a model based on blood pressure readings from 1,959,003 mostly male (96%) veterans who had high rates of chronic diseases, such as diabetes (36%), coronary artery disease (21%), chronic lung disease (15%), sleep apnea (11%), advanced chronic kidney disease (CKD; 7.7%), and atrial fibrillation (7.7%). Having a mean SBP of less than 120 mm Hg was significantly associated with an adjusted 26% increased risk for all-cause mortality, compared with a mean SBP of 130 mm Hg or more, Diana I. Jalal, MD, Masaaki Yamada, MD, and colleagues from The University of Iowa Roy J and Lucille A Carver College of Medicine in Iowa City reported. Death risk increased with age
sion, twice as many patients with
category and was significantly stronger among veterans aged 70 years and older. Results from this retrospective study contrast with findings from the landmark SPRINT trial due to the different populations, use of routine office vs standardized blood pressure measurement, and other factors. Among ambulatory adults aged 75 years or older in SPRINT2, treating to an SBP target of less than 120 mm Hg compared with an SBP target of less than 140 mm Hg resulted in significantly lower rates of major cardiovascular events and death from any cause. However, half of treated patients did not attain SBP of less than 120 mm Hg. In an interview with Renal & Urology News, Dr Yamada explained that findings from their observational study should be interpreted cautiously. “Based on the collective evidence, we believe that the current recommendations by ACC/AHA 2017 are reasonable; that is,
to target a SBP of less than 130 mm Hg in elderly community dwellers, while exercising caution in those with lifelimiting conditions,” Dr Yamada said. The KDIGO 2021 guideline, however, recommends a target of systolic BP less than 120 mm Hg for those with CKD with and without diabetes, Dr Yamada continued. In addition, KDIGO stipulates that it may be harmful to target SBP less than 120 mm Hg based on non-standardized blood pressure measurements. Both guidelines acknowledge that intensive blood pressure management may not be warranted in individuals with life-limiting conditions. “It is important for clinicians to apply the guidelines with a deep understanding of their own outpatient BP measurement procedures and to individualize treatment goals for each patient based on their patients’ overall health and treatment goals,” Dr Yamada said. ■
significantly higher in the AKI group. In the 2 years before the index admisAKI (55.9%) than without (26.5%) had been hospitalized. All-cause mortality rates in the AKI group were a significant 3.0- and 2.4-fold higher at 90 days and 1 year, respectively, compared with the noAKI group. In an interview with Renal & Urology News, Dr Schulman pointed out that sepsis, heart failure, and recurrent AKI — which were significantly more common in the AKI group — were the primary causes of rehospitalization within 90 days and 1 year. “While the best post-AKI clinical management regimen is yet to be determined, these results underscore the immediate need for close posthospitalization monitoring of individuals with AKI,” Dr Schulman said. ■
