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

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 < 45 ml/min/1.73 m2 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 < 90 ml/min/1.73 m2 by CKD-EPI formula; eGFR was measured at baseline and after a median of 28.0 months. Urinary 11-dehydro-TxB2, was measured in 401 patients. The incidence of cardiovascular events (CVEs) was also registered. Results Baseline eGFR was 65.1 ml/min/1.73 m2; 147 and 91 patients had incident eGFR < 60 and < 45 ml/min/1.73 m2, respectively; 16.5% patients received a concomitant treatment with aspirin 100 mg/day. Multivariate logistic regression analysis showed a direct association with incident eGFR < 45 ml/min/1.73 m2 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 < 45 ml/min/1.73 m2 had higher TxB2, compared to those without (123.0 vs. 90.0 ng/mg creatinine, p = 0.031); TxB2 was inversely associated with incident eGFR < 45 ml/min/1.73 m2 (log TxB2 OR 2.239, p = 0.036). Incident eGFR < 45 ml/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.