Clinical study
Early and late effects of low-dose aspirin on renal function in elderly patients

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Abstract

Background

Although low-dose aspirin is used by many elderly patients, monitoring of renal function is currently not recommended. We recently reported transient retention of uric acid and creatinine caused by aspirin in doses of 75 to 325 mg/d. We therefore evaluated the renal effects of aspirin (100 mg/d), including post-treatment effects.

Methods

We studied 83 stable geriatric patients in long-term care (aged 56 to 98 years) who were treated with low-dose aspirin (100 mg/d) for 2 weeks and 40 control patients. Other medications and diet were kept constant. Biochemical monitoring including blood samples and 24-hour urinary collections for creatinine and uric acid at baseline and weekly for a total of 5 weeks.

Results

After 2 weeks on aspirin, urinary excretion of creatinine decreased in 60 (72%) and excretion of uric acid decreased in 54 (65%) of the 83 patients, and their mean clearances decreased; during the same period, serum blood urea nitrogen, creatinine, and uric acid levels increased (P <0.05 for all). Deterioration from baseline levels was significantly greater (and more prevalent) in the aspirin-treated group than in the 40 control patients (P = 0.001 to 0.09). After withdrawal of aspirin these parameters improved. However, 3 weeks after stopping aspirin, 48% (35 of the 73 in whom this measurement was available) had a persistent decline in creatinine clearance from baseline, as compared with only 8% (3/36) controls (P <0.001).

Conclusion

Short-term low-dose aspirin treatment may affect renal function in elderly patients. These effects persist 3 weeks after cessation of the drug in some of these patients.

Section snippets

Patients

Eighty-three elderly residents (67 women and 16 men; mean [± SD] age, 81 ± 9 years) in the long-term geriatric care departments at Shmuel Harofeh Geriatric Medical Center, who had been admitted for a variety of chronic medical conditions, were recruited during a 3-month recruitment period. Informed consent was obtained from the patients or their guardians. The potential benefit of the study for the patients was to enable safer prescription of low-dose aspirin. The study was approved by the

Results

Control patients were somewhat more likely to have diabetes and a lower mean creatinine clearance at baseline, than were those treated with aspirin (Table 1). Seventy-three patients in the treatment group completed the 5-week study; the remaining 10 patients dropped out for various reasons (mainly discharge, acute change in medical condition not related to aspirin, or a necessary change in medication). Four patients in the control group dropped out for similar reasons. Aspirin was well

Discussion

Physicians are aware of the deleterious effects of NSAIDs on glomerular filtration rate, especially in people with borderline or diminished renal function 3, 14, 15, 16. The effects of high-dose aspirin on renal function are less well documented. Although high-dose aspirin is considered relatively safe, medical conditions may increase its risk 10, 11. Aspirin as an anti-inflammatory drug—at doses of 3 g/d—is seldom prescribed. However, aspirin is used widely in lower doses for the prevention of

Acknowledgements

We are in debt to Professor Adrian Iaina for his editorial assistance and to Eylon Neumann, MSc, for his statistical assistance.

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