Abstract 15529: Aspirin and Renal Insufficiency Progression in Patients With Atrial Fibrillation and Chronic Kidney Disease
Introduction: Thromboxane (Tx)A2 is an eicosanoid with aggregating and vasoconstrictor properties. In experimental models, TxA2 reduces renal perfusion and accelerates renal failure, but its role in human pathophysiology is unclear.
Hypothesis: To test the association between the use of aspirin, which inhibits TxA2 production, and the incidence of an estimated Glomerular Filtration Rate (eGFR) <60 and <45 ml/min/1.73 m2 in a long-term follow-up.
Methods: Prospective multicentre observational cohort study including 800 atrial fibrillation (AF) patients affected by chronic kidney disease (CKD) from I Clinica Medica of “Sapienza” University of Rome, from University Magna Græcia of Catanzaro, and from the ARAPACIS study.
CKD was defined as an eGFR <90 ml/min/1.73 m2 by CKD-EPI formula; eGFR was calculated at baseline and after a median of 28.0 months. In 401 patients, urinary 11-dehydro-TxB2 was measured.
Results: Baseline median eGFR was 64.9 ml/min/1.73 m2; 147 and 91 AF patients had an incident eGFR <60 and <45 ml/min/1.73 m2, respectively; 16.5% AF patients were treated with aspirin (100 mg/day) in addition to oral anticoagulants. At multivariable analysis, aspirin was inversely associated with incident eGFR<45 ml/min/1.73 m2 (odds ratio [OR]: 0.367, 95% confidence interval [CI] 0.153-0.880, p=0.025), but not with incident eGFR<60 ml/min/1.73 m2. The effect of aspirin persisted after propensity score adjustment (OR: 0.920, 95%CI 0.857-0.988, p=0.022). Median TxB2 levels were higher in patients with (123.0 ng/mg creatinine) compared to those without incident eGFR <45 ml/min/1.73 m2 (90.0, p=0.031) and significantly associated with incident eGFR<45 ml/min/1.73 m2 (log TxB2 OR 2.239, 95%CI 1.056-4.747, p=0.036). TxB2 was significantly lower in aspirin-treated patients (p=0.014).
Conclusions: TxA2 may be implicated in renal function deterioration in AF patients with CKD.
Author Disclosures: D. Pastori: None. P. Pignatelli: None. F. Perticone: None. A. Sciacqua: None. R. Carnevale: None. A. Farcomeni: None. S. Basili: None. G.R. Corazza: None. G. Davì: None. G. Lip: None. F. Violi: None.
- © 2015 by American Heart Association, Inc.