Aspirin and renal insufficiency progression in patients with atrial fibrillation and chronic kidney disease

Abstract

Background: In experimental models, thromboxane (Tx)A₂ reduced renal perfusion and accelerated renal failure. The aim of the study was to investigate the association between the use of aspirin, which inhibits TxA₂ production, and the incidence of an estimated Glomerular Filtration Rate (eGFR) <60 and <45ml/min/1.73m² in patients with atrial fibrillation (AF) and chronic kidney disease (CKD).

Methods: Prospective multicentre observational cohort study including 800 anticoagulated AF patients; CKD was defined as an eGFR <90ml/min/1.73m² by CKD-EPI formula; eGFR was measured at baseline and after a median of 28.0months. Urinary 11-dehydro-TxB₂, was measured in 401 patients. The incidence of cardiovascular events (CVEs) was also registered.

Results: Baseline eGFR was 65.1ml/min/1.73m²; 147 and 91 patients had incident eGFR<60 and <45ml/min/1.73m², respectively; 16.5% patients received a concomitant treatment with aspirin 100mg/day. Multivariate logistic regression analysis showed a direct association with incident eGFR<45ml/min/1.73m² for female sex (odds ratio [OR]:1.910, p=0.005) and hypertension (OR: 7.589, p=0.047), while aspirin use was inversely associated (OR: 0.347, p=0.016). Propensity score adjustment confirmed this association (p=0.017). Patients with incident eGFR<45ml/min/1.73m² had higher TxB₂, compared to those without (123.0 vs. 90.0ng/mg creatinine, p=0.031); TxB₂ was inversely associated with incident eGFR<45ml/min/1.73m² (log TxB₂ OR 2.239, p=0.036). Incident eGFR<45ml/min was associated with an increased rate of CVEs (HR: 2.211, p=0.01).

Conclusion: Aspirin use was associated with a less decline in eGFR in our cohort of AF patients with CKD. Our findings suggest that TxA₂ may be implicated in renal function deterioration in AF.

Keywords: Arterial hypertension; Aspirin; Atrial fibrillation; Chronic kidney disease; Thromboxane.