Influence of low-dose acetylsalicylic acid on renal function in patients with liver cirrhosis and ascites

Background/Aims Non-steroidal anti-inflammatory drugs are not recommended in cirrhosis with ascites due to acute kidney injury (AKI) risk. Nowadays, more patients require low-dose acetylsalicylic acid (ASA) for cardiovascular prophylaxis. This study aims to evaluate the impact of low-dose ASA on transplant-free survival, renal function, and further decompensation in patients with cirrhosis and ascites.

Methods This is a retrospective unicentric analysis of 1170 consecutive cases with cirrhosis and ascites from 2019 to 2022. Baseline data, including ASA intake, were collected. Follow-up was extended until 12/2023. Endpoints included transplant-free survival, changes in serum creatinine, incidence of AKI, and further decompensation. Variables were compared with T-student and Mann-Whitney U test. Propensity score matching (PSM) and Cox regression analysis was performed.

Results 303 patients (53, 17.5% on ASA) were followed for a median of 350 days. Thirteen (31.0%) ASA patients and 57 (28.5%) controls died or received a transplant, with no difference in transplant-free survival (HR 1.13, 95% CI 0.62-2.10). Seven (16.7%) ASA patients developed AKI, of which three (42.9%) were hepatorenal syndrome (HRS-AKI), compared to 23 (11.4%) AKI cases [7 (30.4%) HRS-AKI] in controls, with no significant differences (AKI: HR 1.46, 95% CI 0.63-3.41; HRS-AKI: HR 1.94, 95% CI 0.50-7.51). After PSM, no differences were observed in transplant-free survival (HR 1.18, 95% CI 0.52-2.64) or AKI/AKI-HRS (AKI: HR 1.83, 95% CI 0.53-6.29; AKI-HRS: HR 2.79, 95% CI 0.29-26.84).

Conclusions Intake of low-dose ASA does not affect transplant-free survival, renal function during follow-up and the incidence of AKI in patients with cirrhosis and ascites.

Publication History

Article published online:
20 January 2025