Aspirin Use in Patients with a Single Kidney

Introduction to Aspirin Therapy

The American College of Cardiology, American Heart Association, and American Stroke Association recommend aspirin for secondary prevention in patients with chronic kidney disease, including those with a single functioning kidney, though with caution about increased bleeding risk 1, 2.
The National Institute for Health and Care Excellence, Kidney Disease: Improving Global Outcomes, and American College of Cardiology consistently recommend aspirin for secondary prevention, with careful consideration of bleeding risk 1, 2.

The recommended dose of aspirin for patients with a single kidney is 75-162 mg daily 4.
Patients with reduced kidney function may have impaired antiplatelet response to aspirin, which may partially explain why aspirin is less effective in chronic kidney disease patients 1, 2.

The risk of major bleeding nearly doubles (RR 2.04) in patients with reduced kidney function 1, 2.
Major bleeding risk increases 33% overall in chronic kidney disease patients on antiplatelet therapy 2, 3.
The risk is particularly elevated if combined with anticoagulants (3-6 fold increase) 7, 8.

Aspirin should be avoided in patients with active bleeding, bleeding tendency, concurrent anticoagulant therapy, recent gastrointestinal bleeding, clinically active hepatic disease, or aspirin allergy 4.
Patients with low body weight (<60 kg) and chronic kidney disease have significantly increased cardiovascular risk with aspirin, and it should be avoided unless there is compelling indication for secondary prevention 6.

If aspirin is prescribed, establish baseline renal function (serum creatinine, eGFR) and monitor for signs of bleeding (gastrointestinal symptoms, bruising, epistaxis) 7, 8, 9.
Consider checking renal function periodically, particularly if other nephrotoxic medications are used 9.