AIMS Cardiovascular disease (CVD) is the major cause of morbidity and mortality in individuals with chronic kidney disease (CKD). This study assessed the risks and benefits of aspirin in the primary prevention of CVD in individuals with CKD. METHODS AND RESULTS Ovid MEDLINE was searched from 2015 to 15th of September 2020 to include randomized controlled trials that assessed aspirin versus placebo in adults with non-end stage CKD without a previous diagnosis of CVD. A pre-specified protocol was registered with PROSPERO (identification number CRD42014008860). A random effects model was used to calculate a pooled hazard ratio (HR), pooled risk difference, and the number needed to treat or harm (NNT/NNH). The primary endpoint was CVD. Secondary endpoints included: all-cause mortality; coronary heart disease; stroke; and major and minor bleeding events. Five trials were identified (n = 7852 total, n = 3935 aspirin, n = 3917 placebo). Overall, 434 CVD events occurred. There was no statistically significant reduction in CVD events (HR 0.76, 95% confidence interval (CI) 0.54-1.08; P = 0.13, I2 = 63%), all-cause mortality (HR 0.94, 95% CI 0.74-1.19; P = 0.60, I2 = 21%), coronary heart disease events (HR 0.66, 95% CI 0.27-1.63; P = 0.37, I2 = 64%) or stroke (HR 0.87, 95% CI 0.6-1.27; P = 0.48, I2 = 24%) from aspirin therapy. The risk of major bleeding events were increased by approximately 50% (HR 1.53, 95% CI 1.13-2.05; P = 0.01, I2 = 0%) and minor bleeding events were more than doubled (HR 2.64, 95% CI 1.64-4.23; P < 0.01, I2 = 0%). CONCLUSIONS Aspirin cannot be routinely recommended for the primary prevention of CVD in individuals with CKD as there is no evidence for its benefit but there is an increased risk of bleeding.

中文翻译：

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阿司匹林用于慢性肾病患者心血管疾病的一级预防：系统评价和荟萃分析。

AIMS 心血管疾病 (CVD) 是慢性肾病 (CKD) 患者发病和死亡的主要原因。本研究评估了阿司匹林在 CKD 患者心血管疾病一级预防中的风险和益处。方法和结果 从 2015 年到 2020 年 9 月 15 日，对 Ovid MEDLINE 进行了检索，纳入了随机对照试验，这些试验评估了阿司匹林与安慰剂在既往无 CVD 诊断的非终末期 CKD 成人中的疗效。预先指定的协议已在 PROSPERO 注册（识别号 CRD42014008860）。使用随机效应模型计算汇总风险比 (HR)、汇总风险差异以及需要治疗或伤害的数量 (NNT/NNH)。主要终点是心血管疾病。次要终点包括：全因死亡率；冠状动脉心脏疾病; 中风; 以及大出血和小出血事件。确定了五项试验（总共 n = 7852，n = 3935 阿司匹林，n = 3917 安慰剂）。总体而言，发生了 434 起 CVD 事件。CVD事件（HR 0.76, 95% CI 0.54-1.08; P = 0.13, I2 = 63%）、全因死亡率（HR 0.94, 95% CI 0.74-1.19; P = 0.60, I2 = 21%)、冠心病事件 (HR 0.66, 95% CI 0.27-1.63; P = 0.37, I2 = 64%) 或中风 (HR 0.87, 95% CI 0.6-1.27; P = 0.48, I2 = 24%) 来自阿司匹林治疗。大出血事件的风险增加了约 50%（HR 1.53，95% CI 1.13-2.05；P = 0.01，I2 = 0%），小出血事件增加了一倍以上（HR 2.64，95% CI 1.64-4.23 ; P < 0.01, I2 = 0%)。