Introduction and methods

Effects of aspirin in primary prevention of CVD in people with chronic kidney disease (CKD): results of the TIPS3 trial

Presented at ERA congress in Paris, France by Johannes Mann (Munich, Germany)

Background

There is limited data on the effect of aspirin on CVD in CKD patients without previous CVD. Previous analyses include ASPREE-CKD in elderly patients and HOT-CKD in patients with hypertension. In the HOT-CKD subanalysis, the benefit of aspirin on prevention of MACE and MI increased with lower eGFR. And although benefit of aspirin on MACE prevention was larger in the CKD group than in the non-CKD group in the ASPREE-CKD analysis, this finding was not statistically significant.

Aim of the study

To examine whether aspirin is effective in the prevention of CVD in people with CKD and no previous CVD (primary prevention setting).

Methods

TIPS-3 was a factorial randomized controlled trial. In this analysis of TIPS-3, data of 5712 patients randomized to aspirin (75 mg/d) or placebo were used. Mean eGFR of this population was 47 mL/min/1.73 m². CKD was defined as eGFR <60 mL/min/1.73 m² (n=983). Mean follow-up was 4.6 years.

Study endpoints

Primary outcome was a composite of MI, stroke, or CV death. Safety endpoint was bleeding.

Main results

• In patients with eGFR <60 mL/min/1.73 m², aspirin resulted in a reduction of MACE compared to placebo (HR 0.57, 95%CI:0.34-0.94). In those with eGFR ≥60 mL/min/1.73 m², there was no effect of aspirin (HR 0.95, 95%CI:0.71-1.27. There was no significant interaction for eGFR (Pinteractie=0.14).
• An analysis of eGFR tertiles showed a trend (P=0.02) for the effect of aspirin on MACE by eGFR (larger effect with lower eGFR).
• There was no difference in bleeding (major, minor, or GI) with aspirin vs. placebo in different eGFR subgroups.

Conclusions

These findings from an subanalysis of TIP-3 suggest that use of aspirin may reduce the CVD burden in patients with CKD but no history of CVD. Bleeding risk was low in this population of patients.

Johannes Mann said that we will be further informed by the ATTACK study – the first trial with the primary objective to examine aspirin in CVD-prevention in CKD-ND (non-dialysis) patients, which is expected to end in 2025.

- Our reporting is based on the information provided at the ERA congress 2022 -