ATTACK

Status

Follow-up

Contact

attack@nottingham.ac.uk

Lead Investigator

Professor Hugh Gallagher

Consultant Nephrologist

Epsom and St Helier University Hospitals NHS Trust

What is the study about?

Chronic Kidney disease (CKD) is a term used by doctors when the kidneys are not working as well as they should. It is very common and affects as many as one in eight adults in the UK.

CKD is important because it is linked to a much higher chance of heart attacks and strokes. On average 2 or 3 of every 100 people with CKD will have a heart attack or stroke every year. The risk of heart attack or stroke in people with mild CKD is double the risk in people with normal kidney function. The risk increases to five times as high as CKD worsens. We therefore need to find ways to reduce these risks.

Heart attacks and strokes are usually caused by small blood clots. Aspirin thins the blood. This reduces the chance that clots will form but also leads to an increased risk of bleeding. Studies in people with previous heart attacks or strokes show that aspirin reduces the risk of further attacks, and that these benefits are much greater than the risks of bleeding. As a result, aspirin is recommended for people (both with CKD and without CKD) who have already had a heart attack or stroke. Aspirin is less beneficial in preventing a first attack or stroke in the general population and is generally not recommended for this purpose.

As heart attacks and strokes are far more common in people with CKD than in the general population, we would expect aspirin to be of greater benefit, but the risks may also be higher as bleeding is more common in people with reduced kidney function. Before we can recommend aspirin treatment to help a first heart attack or stroke in people with CKD, we need to be sure that the benefits of treatment outweigh the possible risks.

Who can take part in the study?

Patients over 18 who have tests in their medical record that suggest that their kidneys are not working normally and receive a letter from their GP inviting them to take part in the trial.

What is being tested in the study?

Taking low-dose aspirin once a day in addition to regular prescribed medication

What is this being compared to?

Continuing with regular medication alone

What are we trying to find out?

There is already some evidence suggesting that aspirin is effective in preventing a first heart attack or stroke in people with CKD and that the benefits outweigh the risks, but the evidence is not conclusive. The results of our research study will indicate more clearly whether people with chronic kidney disease (CKD) should take daily low-dose aspirin to reduce the risk of a first heart attack or stroke.