Okay. I am confused about the whole aspirin issue.

[Bub]

I have been told by the nurses at my dialysis center to never take aspirin.  They would not even let me take pep-to bismal (contains aspirin?).  Now seeing posts from people who are on dialysis and are taking aspirin daily for their heart.  Can we or cant we?  Should we or shouldn't we? Does it vary from doctor to doctor, or vary from patient to patient?

[cariad]

I think it's a bit of both, Bub. I was always told don't take aspirin, but that was because of med interactions, not dialysis. I would check with your doctor to see if aspirin's benefits outweigh the risks for you.

[sullidog]

I'm only aloud tylenol and tylenol only. That's the most I've heard from our doctors here locally.
Troy

[Red from Canada]

I am told to take an 81 mg aspirin daily for my heart.  I guess it depends on the doctor and what other meds and health problems you have.

[Malibu]

MM takes 1/2 a regular aspirin a day. Has for 2 years, Feb is our 3rd mo of dialysis.

[dwcrawford]

Why be confused?  Red from Canada gave the definitive answer.

I am told to take an 81 mg aspirin daily for my heart.  I guess it depends on the doctor and what other meds and health problems you have.

[okarol]

[Here is a related article, regarding aspirin for hemodialysis patients, but as mentioned by others, it depends on what other medications you are taking.]

Daily Aspirin Use Associated With Enhanced Fistula Survival

Norra MacReady

June 26, 2007 (Barcelona) — An aspirin a day helps hemodialysis patients keep their arteriovenous fistulas (AVFs) functioning, Takeshi Hasegawa, MD, PhD, reported here at the 44th European Renal Association–European Dialysis and Transplantation Association Congress.

Dr. Hasegawa's data were generated from the Dialysis Outcomes and Practice Patterns Study (DOPPS), an ongoing, international study of hemodialysis patients and clinical practices funded by Amgen and Kirin Brewery. The main goal of the study is to maximize the longevity of patients on hemodialysis by improving practices at dialysis facilities.

Of the 3 types of vascular access for dialysis (AVF, graft, and catheter), AVF is considered the gold standard and is recommended in many clinical practice guidelines, said Dr. Hasegawa, from the Department of Epidemiology and Healthcare Research in the Graduate School of Medicine and Public Health at Kyoto University in Japan, and a visiting scholar at the Arbor Research Collaborative, Ann Arbor, Michigan, where he is working on the DOPPS.

Some important questions remain about AVFs, including the value of patients taking aspirin to prevent fistulas from clotting, study coauthor Ronald L. Pisoni, PhD, MS, senior scientist and director of analytic support for DOPPS, told Medscape. The fistulas must be surgically created and require anywhere from 2 weeks to 3 months to "mature" enough to withstand dialysis, so fistula failure means subjecting patients to multiple operations and increases the likelihood that the patients will end up with a different type of vascular access.

In this study, the investigators evaluated the association between aspirin use and AVF survival in a multivariable logistic regression analysis of data on 2649 hemodialysis patients at more than 300 randomly selected dialysis facilities around the world. All of the patients had been on dialysis for fewer than 30 days and were using an AVF when they were enrolled in the DOPPS. Only consistent aspirin users were included in the analysis. Consistent use was defined as aspirin use both at baseline and 1 year later.

The patient characteristics most closely associated with aspirin use included male sex; older age, with an adjusted odds ratio (AOR) of 1.15 for each decade; coronary artery disease; cerebrovascular disease; hypertension; and diabetes mellitus (P < .05 for all associations). Living in Japan was a significant negative association, with an AOR of 0.41 compared with living in North America (P < .05).

At baseline, 21.4% of all patients were taking aspirin, but there was considerable international variation, ranging from a low of 11.4% in Japan to a high of 24.7% in North America, said Dr. Hasegawa. Nevertheless, aspirin use at baseline was associated with a hazard ratio of 0.70 for complete AVF failure, compared to no baseline aspirin use (P = .05). Among patients reporting a history of consistent aspirin use, the hazard ratio for complete AVF failure was 0.56 compared with patients with no history of aspirin use (P = .03). Aspirin use during the study period was not significantly associated with new gastrointestinal bleeding events.

The dosing data were not presented because they have not yet been analyzed, Dr. Pisoni said.

Francisco Ortega, MD, who cochaired the session at which these data were presented, noted that the consistent aspirin users in this analysis had higher hemoglobin levels than patients who did not use aspirin. "What is the relationship between the level of hemoglobin and the use of aspirin?" asked Dr. Ortega, from the Nephrology Unit, Hospital Central de Asturias, in Oviedo, Spain. He was not associated with this study and reports no relevant financial relationships.

Some nephrologists may worry that high hemoglobin levels may increase the risk of AVF failure, so they may want to prescribe aspirin only prophylactically, Dr. Hasegawa replied.

"These results suggest that consistent aspirin use is beneficial for AVF survival among hemodialysis patients," Dr. Hasegawa concluded. "It is expected that these findings may facilitate efforts at prolonging AVF survival in hemodialysis patients, and thereby improve practice patterns in this area for better hemodialysis patient outcomes."

European Renal Association–European Dialysis and Transplantation Association 44th Congress: Abstract SuO024. Presented June 24, 2007.

[okarol]

The National Kidney Foundation has more info about heart health, dialysis and mentions aspirin use: http://www.kidney.org/atoz/content/hearthealthydialysis.cfm

[RightSide]

My neph is also a professor of nephrology.  He told me that while there is evidence that a high dose of aspirin (like the dose that arthritis suffers take regularly) can damage the kidneys, there is no evidence that LOW-dose aspirin can damage the kidneys.

And so, he's told me to take low-dose aspirin regularly to help prevent cardiovascular disease. 

[kristina]

My neph is also a professor of nephrology.  He told me that while there is evidence that a high dose of aspirin (like the dose that arthritis suffers take regularly) can damage the kidneys, there is no evidence that LOW-dose aspirin can damage the kidneys.

And so, he's told me to take low-dose aspirin regularly to help prevent cardiovascular disease.

What is a high dose and what is a low dose?

Thanks Kristina.

[billybags]

My husband takes a low dose daily for his heart.

[calypso]

My neph is also a professor of nephrology.  He told me that while there is evidence that a high dose of aspirin (like the dose that arthritis suffers take regularly) can damage the kidneys, there is no evidence that LOW-dose aspirin can damage the kidneys.

And so, he's told me to take low-dose aspirin regularly to help prevent cardiovascular disease.

What is a high dose and what is a low dose?

Thanks Kristina.

Low dose is 81mg, high dose is over 300mg, I think 325mg?

[kristina]

Thank you, Calypso, your answer is very much appreciated.
I am still wondering if the dosage of Aspirin is sometimes
"tailored" to the weight of the patient?
Has anyone ever heard of this?
Thanks Kristina.

[calypso]

Thank you, Calypso, your answer is very much appreciated.
I am still wondering if the dosage of Aspirin is sometimes
"tailored" to the weight of the patient?
Has anyone ever heard of this?
Thanks Kristina.

I haven't heard of that but it could be for a specific purpose. Is there a specific reason for the use of aspirin you have in mind?

Upon further research I've come to find out low dose is anywhere from 75 to 81mg, and high dose is anywhere from 325 to 1000mg. 1000mg being the maximum dose and probably not prescribed anymore considering there are better alternatives with fewer side effects.
For example ibuprofen is a better pain reliever than aspirin and less irritating to the stomach lining.

Low dose aspirin is prescribed for daily use long term as a blood thinner to prevent heart attacks, strokes and even fistula clotting.
High dose is for pain relief and not to be used daily long term, but like I said there are better pain relievers with fewer side effects now.

[kristina]

Thanks very much for your research, calypso.
I am taking a "small dose" of 75 mg Aspirin every day
because of the stroke I suffered in 1991
& I feel I need to keep a check
because it has been such a long time
of my taking these 75 mg of Aspirin every day.

Thanks again from Kristina.

[girliekick]

i take 81mg  for a clotting disorder, i do pd.  take coated asprin it is easier on the stomach.  i choose to take the asprin over cummidin. Seemed less risky.   does asprin effect teeth sensitivity?
Girl

[kristina]

I also suffer from teeth sensitivity but I am unsure what causes it.
Having taken the 75 mg Aspirin per day for so many years I know
it is probably the cause of bruising but in recent years particularly over the last year
I have found I bleed very easily (nose & cuts) & this has caused me some concern
because sometimes the bleeding is spontaneous & this makes me feel not only vulnerable
but it also makes me think what is going on inside my body.
I take soluble Aspirin and my stomach seems to tolerate it very well.
In the past I have tried to enquire from medics about this
but I did not seem to get anywhere in receiving good answers
or sound medical advice about this matter.

[dwcrawford]

See my point, Kristina and girl.  I used to take 81 due to atrial fibrilation (heart thing) but the onocologis told me to stop due to Low blood platelets and possible bleeding.  Now I have no idea but monthly I have to give all medication names and amts. to the neph (including supplements, vitamins, etc.) who has then input into the computer and oncologist, cardiologist, neph and internest... can looks (since it is all the same hospital system)...
I respect more the advise of my internist but he then says the Neph must be in charge now.  so as long as all four concur. who am I to question it.  Tylenol is better for pain anyway.

Once again, thank god for the American system of health care for me and pity the ones who don't have it.  So selfish isn't it?

Please don't take off for spellilng all the health care words...doctors, meds. etc.

[RightSide]

What is a high dose and what is a low dose?

"High dose" aspirin is the usual dose of aspirin you would take for a headache or fever:  Two 325 mg tablets for a total of 650 mg aspirin.  (Some folks take "Extra Strength" aspirin which is even more:  Two 500 mg tablets for a total of 1,000 mg aspirin.)

The "low dose" aspirin that's prescribed for prevention of cardiovascular problems is one 81 mg tablet per day.  Nowadays the drugstores sell this special "low dose" aspirin for this purpose.

[kristina]

Thanks RightSide, now we have got the "high" and "low" dose of Aspirin explained,
but we don't know the effects of Aspirin over a long period.
Is there anyone out there who has been taking a "low" dose of Aspirin
for 10 years or more and have they noticed side-effects
which gives them concern?
Thanks from Kristina.

[Red from Canada]

Kristina....I have been taking coated low dose aspirin for 11 years with no side effects whatsoever.

[RightSide]

Thanks RightSide, now we have got the "high" and "low" dose of Aspirin explained,
but we don't know the effects of Aspirin over a long period.
Is there anyone out there who has been taking a "low" dose of Aspirin
for 10 years or more and have they noticed side-effects
which gives them concern?
Thanks from Kristina.

There are a few known side effects, but kidney damage isn't one of them.

Low-dose aspirin can cause peptic ulcers just like high-dose aspirin can, though presumably the risk for the low dose is lower.

And if you already have kidney failure, the kidneys can't get rid of the metabolites of aspirin quickly enough, one of which is uric acid. That can exacerbate gout in susceptible patients.

Obviously aspirin can interact with anticoagulants like heparin to further retard clotting.  I take my low-dose aspirin after dialysis, with my dinner.  That delays its absorption until most of the heparin is gone from my body.

[texasstyle]

I'm sitting here kinda giggling NOT because of the seriousness of the question, but because t kinda reminds me of some things I see on tv. You know how they report on the news that coffee is really good to drink because it decreases chances of diabetes, then 6 months later they say oh, too much coffee is bad for the eyes now lol.It's hard to tell what's right or wrong. Gee it sure gets confusing.

[kristina]

Thank you very much for your kind answers.
I agree, that there are many issues which are terribly confusing
& that is why it is so good to exchange our thoughts and experiences.

Now, here is another aspect of the Aspirin issue.
The medics prescribe either a“high” dose or a “low” dose of Aspirin,
BUT how does this configure with the weight of a person?
 
For example, someone who is 126 lbs (9 stones) ~ 57.5 kg,
who takes a low dose of Aspirin, would the potency be diluted to a larger degree
in a person who is twice this weight say 252 lbs (18 stones) ~115 kg?
You can see the implication here.
 
If the dose of Aspirin is perfect, medically, for the person of 252 lbs
then it would appear to the layman that the same dose of Aspirin
would be more potent (perhaps more potent in its side-effects)
in a person half that weight at 126 lbs – or vice versa.

So here is another important riddle in the Aspirin issue.
Has anyone any thoughts on this?

I have tried to ask medics about this in the past
but they did not come up with any answers &
I have not come across any research on this.

I am concerned this issue because I don’t know
whether I am on the correct level of Aspirin, particularly
because I have been taking it for so long and I have developed problems
with spontaneous nose-bleeding, bruising when scratching a little etc.

Thanks again, Kristina.

[Hanify]

I am 72kgs and 5'7" tall - so am slim-ish.  I have only had one drug (my chemo) that was worked out on my weight.  every other drug they give me is a standard one and it is the same for a really big person.  it's a good point you bring up Kristina.  Aren't I therefore getting way more everything than a person twice my size?