Is It Safe to Take Aspirin in Chronic Kidney Disease?

[okarol]

This is from: http://kidneydiseases.about.com/od/medications/a/aspirinckd.htm

Aspirin and Chronic Kidney Disease

About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

Is It Safe to Take Aspirin in Chronic Kidney Disease?

Health care providers are less likely to prescribe aspirin for someone at risk for heart disease if they have chronic kidney disease (CKD) as opposed normal kidney function. This is usually because of concerns about harming the kidneys, worsening kidney dysfunction, and/or increasing the risk of bleeding. Although it usually a good idea to limit the amount of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) that one takes in CKD, a low-dose daily aspirin should probably not be withheld unless there is a good reason to (e.g., aspirin allergy, significant bleeding risk, etc).

The risk of cardiovascular disease, including heart attacks, is extremely high in CKD. Although the issue of using aspirin to prevent heart attacks in someone with CKD hasn't been extensively studied, many kidney doctors (including myself) believe the benefits of taking a low-dose daily aspirin probably outweighs the risks.
Harming the Kidneys
There has been a lot of concern that long-term use of painkillers may harm the kidneys. The strongest link between the risk of kidney disease and the overuse of painkillers was found with a drug called phenacetin, which is chemically related to acetaminophen. Fortunately, phenacetin was voluntarily removed from the U.S. market in the 1980s.

There is no evidence that a low dose of daily aspirin (81mg) hurts the kidney. Nonetheless, it is still recommended to avoid using NSAIDs (including aspirin and other salicylates) in large doses or for extended periods of times.

Causing Kidney Dysfunction
In a number conditions (including advanced kidney, liver or heart failure), the kidneys may rely on locally produced hormones to help keep them from overreacting to certain body signals. NSAIDs (including aspirin and other salicylates) may disable this protective mechanism, thus leading to worsening kidney function. This can cause a drop in your glomerular filtration rate well as an accumulation of sodium, potassium and fluids. However, a low dose of daily aspirin usually doesn't cause that much of a problem.

If necessary, your doctor can monitor for an effect on your kidney function by ordering periodic blood tests. It should also be noted that kidney problems seen with NSAIDs can be made worse by taking ACE inhibitors at the same time.
Increasing Risk for Bleeding
The biggest concern about taking aspirin in CKD is bleeding, especially gastrointestinal bleeding. This is because in advanced kidney disease, a person’s platelets don’t work as well. Because aspirin keeps platelets from working normally, there can be concern that it will make someone with kidney failure be at an even greater risk for bleeding. Again, a baby dose of aspirin is unlikely to be a problem if someone is not actively bleeding.

Your primary care doctor, kidney doctor, or heart doctor can help assess your individual risk for bleeding with aspirin. Sources:

McMahon and Parfrey. “Cardiovascular Aspects of Chronic Kidney Disease.” Brenner & Rector’s The Kidney 7th Edition. Ed. Barry M. Brenner. Philadelphia: Saunders, 2004. 2196-2207.
Updated: July 5, 2007

[rimbo74]

and all this time I thought I just had to stay away from Ibuprofen

[flip]

Accoding to my Nephrologist.......NO WAY!

[okarol]

Jenna has been taking one baby aspirin a day since her transplant. It was prescribed by her transplant team because it has been shown to be beneficial to minimize clots and to keep patient's hearts healthy. Beyond that, she is only allowed Tylenol for pain.

[paris]

My neph said the same thing as Jenna's----baby aspirin once a day and only tylenol for pain.       The way I feel today, big strong pain killers sound good!

[flip]

I've still got a big bottle left from my fistula opeation. I figure that if it ever stops buzzing, I'll take some and get a really good buzz.

[Deanne]

My neph has had me on a full-dose aspirin once a day for several years.

[stauffenberg]

Another bad effect of aspirin in renal patients is that it is profoundly acidifying, and since everyone with imparied renal function is predisposed already to acidosis, why make things worse?

The studies which showed a benefit in preventing heart disease in groups taking aspirin never studied whether this benefit also existed in people with an enormously increased risk of heart disease due to other factors, such as renal patients.  For renal patients, taking aspirin to reduce heart disease is like thinking you're clever to turn off the garden hose during a flood so as to reduce the water levels.  The effect of aspirin will be just swamped by the massive pro-cardiac disease effects of renal disease.

I considered taking some aspirin every day for vascular health way back in 1978 when the first studies suggested this might be beneficial.  I decided against it then, however, since research also showed that constant aspirin dosing damages the kidneys. 

[NolaGail]

Tylenol has been the only thing that I have been allowed to take that's OTC.  Now, don't mess with my Darvocet!

NolaGail

[okarol]

I considered taking some aspirin every day for vascular health way back in 1978 when the first studies suggested this might be beneficial.  I decided against it then, however, since research also showed that constant aspirin dosing* damages the kidneys. 

* Again, dosage should be approved by your physician.

I found this at the Mayo website - it's general info, not just for kidney patients, but worth reading:

What are the possible side effects of daily aspirin therapy?

Even if you do have risk factors for heart attack or stroke, don't pop open your aspirin bottle just yet. If you're already taking an anticoagulant such as warfarin (Coumadin) for another condition, combining it with aspirin may greatly increase the risk of major bleeding complications. However, there may be some conditions for which combining a low dose of aspirin with warfarin is appropriate (for example, with certain types of artificial heart valves for secondary stroke prevention), but this therapy always needs to be carefully discussed with your doctor.

Other medications and herbal supplements also may increase your risk of bleeding. Be sure to talk to your doctor about all of your medications — prescription and over-the-counter — and any supplements that you're taking, before beginning daily aspirin therapy.

Side effects and complications of taking aspirin include:

    * Hemorrhagic stroke. While daily aspirin can help prevent a clot-related stroke, it may increase your risk of a bleeding stroke (hemorrhagic stroke).
    * Gastrointestinal bleeding. Daily aspirin use increases your risk of developing a stomach ulcer. And, if you have a bleeding ulcer, taking aspirin will cause it to bleed more, perhaps to a life-threatening extent.
    * Allergic reaction. If you're allergic to aspirin, taking any amount of aspirin can trigger a serious allergic reaction.
    * Ringing in the ears (tinnitus) and hearing loss. Too much aspirin (overdosing) can cause tinnitus and eventual hearing loss in some people.

If you're taking aspirin and you must undergo even a simple surgical procedure or dental work, be sure to tell the surgeon or dentist that you take daily aspirin and how much. Otherwise you risk excessive bleeding during surgery.

The Food and Drug Administration also warns that people who regularly take aspirin should limit the amount of alcohol they drink because of its additional blood-thinning effects and potential to upset your stomach. If you take daily aspirin therapy, you should not have more than one drink a day if you're a woman or two drinks a day if you're a man.   MORE INFO: http://www.mayoclinic.com/health/daily-aspirin-therapy/HB00073

[kellyt]

I also take one Asprin daily on doctor's orders.  However, it has to be a "coated" Asprin.  Tylenol for pain, as well. 

I just bought some Tylenol PM.  Can we take that?  I've been to scared to take it until I talk to my Neph.

[okarol]

Tylenol PM is just Tylenol with an antihistimine similar to Benadryl to make you sleepy.

[kellyt]

Excellent.  Thanks!   

[paris]

Kelly, hope the tylenol pm gives you a good nights sleep!

[kellyt]

Thanks.  Now that I've cleared up my nasal congestion maybe I can sleep.  I got some meds from my allergist, but, of course, not a decongestant.  I took what he gave me.  I have no idea if it worked or not because on that same day I realized I hadn't changed my A/C filter in a while.  I pulled it out and it was horribly dirty!  Also, my husband some boxes stacked against the air vent that sucks air in.  I changed the filter and moved the boxes and what do you know....I CAN BREATHE!  Honestly, I don't know what cured me, but I'm thankful nonetheless!!!   I may just take the Tylenol PM just for shits and grins tonight!!!   

[KT0930]

I've been told only Tylenol for pain for as long as I can remember! My transplant team did the same as many others, and I am on a baby aspirin (81 mg) per day since the transplant, and no plans to stop it that I know of.

[Loretta]

I take Tylenol and Benadryl  over the counter but nothing else.  I am on Coumadin for blood clotts, so don't need aspirin.  I should maybe ask about the Benadryl and get a presciption for allergies, but the allergies are better than they where before ESRD. 

[KT0930]

Loretta, the Benadryl should be fine. I've been told by two nephs when I couldn't sleep that Benadryl was the way to go - once when I had a functioning transplant, and once while on dialysis. However, since it made me sleepy, I didn't want to take it for allergies, so I asked for a prescription and was given Allegra (fexofenodine).

[flip]

I go the benadryl route. If that doesn't work, I take a phenergen. Better living thru chemistry.