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Aspirin use in chronic kidney disease: Is cardiovascular risk reduction worth the risk?

Patrick J Kramer, Niraj Desai

Chronic kidney disease patients are at increased risk of atherothrombotic cardiovascular disease but are also at high risk of bleeding complications. Aspirin is an overall safe and efficacious therapy for the secondary prevention of CVD in certain populations. However, its use as primary prevention has not been proven to be of benefit and is counterbalanced by high risk of adverse events in patients with kidney disease. In this review, we present relevant differences in pathophysiology of CVD in patients with impaired kidney function and discuss the balance between benefit and harm and review controversial aspects of aspirin therapy for both primary and secondary prevention of cardiovascular disease in patients with CKD.