Follow-up of aspirin-resistant patients with end-stage kidney disease

Background

Aspirin resistance is defined by platelet function testing and presumed clinical unresponsiveness to aspirin. Aspirin-resistant patients are at a greater risk of clinically important adverse cardiovascular events. We aimed to investigate whether end-stage renal disease patients with aspirin resistance are at increased risk for long-term major adverse clinical events.

Methods

We prospectively enrolled 78 end-stage renal disease patients between January 2008 and November 2008. The effect of aspirin on platelet functions was determined using a new generation impedance aggregometer (Multiplate analyser, Dynabyte Medical, Munich). The primary end-point was the composite of death, myocardial infarction, unstable angina, or cerebrovascular accident. Mean follow-up was 20.7 ± 6.1 months.

Results

Of the patients studied, 34 (43.58 %) were aspirin resistant and 44 (56.42 %) were not aspirin resistant. Among patients who were aspirin resistant, 13 of 34 (38.2 %) experienced death, MI, or CVA, compared to 7 of 44 (15.9 %) patients who were not aspirin resistant (p = 0.034). Multivariate analyses identified aspirin resistance to be independently associated with major adverse long-term outcomes ([HR] 2.722; 95 % CI, 1.068–6.942; p = 0.04).

Conclusion

This study demonstrates that end-stage kidney disease patients resistant to aspirin are at a greater risk of long-term major adverse events than patients who are sensitive to aspirin.