R. Brooks Robey, MD; Daniel J. O'Rourke, MD
Potential Conflicts of Interest: None disclosed.
Robey R., O'Rourke D.; Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease. Ann Intern Med. 2012;157:302-303. doi: 10.7326/0003-4819-157-4-201208210-00024
Download citation file:
Published: Ann Intern Med. 2012;157(4):302-303.
TO THE EDITOR:
The systematic review and meta-analysis by Palmer and colleagues (1) found limited objective evidence to support antiplatelet therapy in patients with CKD. We concur with their assessment but believe that they underestimated the benefits and overemphasized the risks by introducing subjective bias into their analysis and interpretation of the data.
Several of the study authors previously reported reduced cardiovascular events and mortality in hypertensive patients with CKD receiving low-dose aspirin relative to their counterparts with normal kidney function (2, 3). Apparent benefits were observed in all outcome categories and were greatest in patients with stage 3B or greater CKD (estimated glomerular filtration rate <45 mL/min per 1.73 m2), where treatment was associated with up to 40-fold lower event rates (2). Benefits were markedly diminished when patients with stage 3A CKD were included in the analysis (estimated glomerular filtration rate <60 mL/min per 1.73 m2). These data, included in the subsequent meta-analysis, account for over 40% of all patients in some outcome categories (1). Unfortunately, the study design ignored this previously defined major benefit threshold in favor of unstratified data analysis. We suspect that this decision was based on limited availability of properly stratified data and considerations of statistical and clinical heterogeneity. However, by combining data sets with established outcome differences, Palmer and colleagues knowingly introduced subjective bias into their analysis.
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only