***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Chronic kidney disease is an important cause of global mortality and morbidity . Data for epidemiological features of chronic kidney disease and its risk factors are limited for low-income and middle-income countries . The International Society of Nephrology 's Kidney Disease Data Center ( ISN-KDDC ) aim ed to assess the prevalence and awareness of chronic kidney disease and its risk factors , and to investigate the risk of cardiovascular disease , in countries of low and middle income . METHODS We did a cross-sectional study in 12 countries from six world regions : Bangladesh , Bolivia , Bosnia and Herzegovina , China , Egypt , Georgia , India , Iran , Moldova , Mongolia , Nepal , and Nigeria . We analysed data from screening programmes in these countries , matching eight general and four high-risk population cohorts collected in the ISN-KDDC data base . High-risk cohorts were individuals at risk of or with a diagnosis of either chronic kidney disease , hypertension , diabetes , or cardiovascular disease . Participants completed a self-report question naire , had their blood pressure measured , and blood and urine sample s taken . We defined chronic kidney disease according to modified KDIGO ( Kidney Disease : Improving Global Outcomes ) criteria ; risk of cardiovascular disease development was estimated with the Framingham risk score . FINDINGS 75,058 individuals were included in the study . The prevalence of chronic kidney disease was 14·3 % ( 95 % CI 14·0 - 14·5 ) in general population s and 36·1 % ( 34·7 - 37·6 ) in high-risk population s. Overall awareness of chronic kidney disease was low , with 409 ( 6 % ) of 6631 individuals in general population s and 150 ( 10 % ) of 1524 participants from high-risk population s aware they had chronic kidney disease . Moreover , in the general population , 5600 ( 44 % ) of 12,751 individuals with hypertension did not know they had the disorder , and 973 ( 31 % ) of 3130 people with diabetes were unaware they had that disease . The number of participants at high risk of cardiovascular disease , according to the Framingham risk score , was underestimated compared with KDIGO guidelines . For example , all individuals with chronic kidney disease should be considered at high risk of cardiovascular disease , but the Framingham risk score detects only 23 % in the general population , and only 38 % in high-risk cohorts . INTERPRETATION Prevalence of chronic kidney disease was high in general and high-risk population s from countries of low and middle income . Moreover , awareness of chronic kidney disease and other non-communicable diseases was low , and a substantial number of individuals who knew they were ill did not receive treatment . Prospect i ve programmes with repeat testing are needed to confirm the diagnosis of chronic kidney disease and its risk factors . Furthermore , in general , health-care workforces in countries of low and middle income need strengthening . FUNDING International Society of Nephrology BACKGROUND We investigated aspirin-prescribing patterns and potential benefits on cardiovascular morbidity and mortality  in hemodialysis patients . STUDY DESIGN Cohort study . SETTING & PARTICIPANTS Data included 28,320 r and omly selected hemodialysis patients from the Dialysis Outcomes and Practice Patterns Study I and II . PREDICTOR Aspirin prescription at study baseline . OUTCOMES & MEASUREMENTS Prescription was investigated by means of logistic regression . All-cause mortality , all-cause hospitalization , cardiac event , myocardial infa rct ion , cerebrovascular ( CVA ) , gastrointestinal bleed , transient ischemic attack , and subdural hematoma were examined . Cox regression examined the risk of mortality and hospitalization . All models accounted for facility clustering and demographics and comorbid conditions . RESULTS Wide variation was found in aspirin prescription , from 8 % in Japan to 41 % in Australia and New Zeal and . Characteristics significantly associated with increased odds of prescription included coronary artery disease , cerebrovascular disease , diabetes , male sex , nonblack race , peripheral vascular disease , age , hypertension , and absence of gastrointestinal bleeding .  Aspirin was associated with decreased risk of stroke in all patients ( relative risk [ RR ] , 0.82 ; P < 0.01 ) and increased risk of myocardial infa rct ion ( RR , 1.21 ; P = 0.01 ) and cardiac event ( RR , 1.08 ; P < 0.01 ) in all patients , with similar results for patients with coronary artery disease . There was no increase in gastrointestinal bleeding . LIMITATIONS Observational studies are not protected from biases , despite adjustments . There is potential for aspirin use to be underreported because of its availability without prescription . CONCLUSIONS The hypothesis that prescribing aspirin to hemodialysis patients decreases cardiovascular disease risk is not supported . Aspirin might decrease CVA and appears not to increase hemorrhagic risk . This should be an incentive for r and omized controlled trials BACKGROUND Patients with chronic kidney disease are at increased risk for cardiovascular disease , but the efficacy and safety of simvastatin and aspirin are unknown in this patient group . METHODS Patients were r and omly assigned in a 2 x 2 factorial design to the administration of : ( 1 ) 20 mg of simvastatin daily versus matching placebo , and ( 2 ) 100 mg of modified-release aspirin daily versus matching placebo . RESULTS Overall , 448 patients with chronic kidney disease were r and omly assigned ( 242 predialysis patients with a creatinine level > or = 1.7 mg/dL [ > or = 150 micromol/L ] , 73 patients on dialysis therapy , and 133 patients with a functioning transplant ) . Compliance with study treatments was 80 % at 12 months . Allocation to treatment with 100 mg of aspirin daily was not associated with an excess of major bleeds  ( aspirin , 4 of 225 patients [ 2 % ] versus placebo , 6 of 223 patients [ 3 % ] ; P = not significant [ NS ] ) , although there was a 3-fold excess of minor bleeds ( 34 of 225 [ 15 % ] versus 12 of 223 patients [ 5 % ] ; P = 0.001 ) . Among those with predialysis renal failure or a functioning transplant at baseline , aspirin did not increase the number of patients who progressed to dialysis therapy ( 7 of 187 [ 4 % ] versus 6 of 188 patients [ 3 % ] ; P = NS ) or experienced a greater than 20 % increase in creatinine level ( 63 of 187 patients [ 34 % ] versus 56 of 188 patients [ 30 % ] ; P = NS ) . After 12 months of follow-up , allocation to 20 mg of simvastatin daily reduced nonfasting total cholesterol levels by 18 % ( simvastatin , 163 mg/dL [ 4.22 mmol/L ] versus placebo , 196 mg/dL [ 5.08 mmol/L ] ; P < 0.0001 ) , directly measured low-density lipoprotein cholesterol levels by 24 % ( 89 mg/dL [ 2.31 mmol/L ] versus 114 mg/dL [ 2.96 mmol/L ] ; P < 0.0001 ) , and triglyceride levels by 13 % ( 166 mg/dL [ 1.87 mmol/L ] versus 186 mg/dL [ 2.10 mmol/L ] ; P < 0.01 ) , but there was no significant effect on high-density lipoprotein cholesterol levels ( 2 % increase ; P = NS ) . Allocation to simvastatin therapy was not associated with excess risk for abnormal liver function test results or elevated creatine kinase levels . CONCLUSION During a 1-year treatment period , simvastatin , 20 mg/d , produced a sustained reduction of approximately one quarter in low-density lipoprotein cholesterol levels , with no evidence of toxicity , and aspirin , 100 mg/d , did not substantially increase the risk for a major bleeding episode . Much larger trials are now needed to assess whether these treatments can prevent vascular events OBJECTIVES The purpose of this study was to determine the benefit and risk associated with antiplatelet therapy in the chronic kidney disease ( CKD ) population . BACKGROUND Cardiovascular and possibly bleeding risks are elevated in patients with CKD . The balance of benefit and harm associated with antiplatelet therapy remains uncertain . METHODS The HOT ( Hypertension Optimal Treatment ) study r and omly assigned participants with diastolic hypertension  to aspirin ( 75 mg ) or placebo . Study treatment effects were calculated using univariate proportional hazards regression models stratified by baseline estimated glomerular filtration rate ( eGFR ) with trends tested by adding interaction terms . End points included major cardiovascular events , total mortality , and major bleeding . RESULTS The study included 18,597 participants treated for 3.8 years . Baseline eGFR was < 60 ml/min/1.73 m(2 ) in 3,619 participants . Major cardiovascular events were reduced by 9 % ( 95 % confidence interval [ CI ] : -9 % to 24 % ) , 15 % ( 95 % CI : -17 % to 39 % ) , and 66 % ( 95 % CI : 33 % to 83 % ) for patients with baseline eGFR of ≥ 60 , 45 to 59 , and < 45 ml/min/1.73 m(2 ) , respectively ( p trend = 0.03 ) . Total mortality was reduced by 0 % ( 95 % CI : -20 % to 17 % ) , 11 % ( 95 % CI : -31 % to 40 % ) , and 49 % ( 95 % CI : 6 % to 73 % ) , respectively ( p trend = 0.04 ) . Major bleeding events were nonsignificantly greater with lower eGFR ( hazard ratio [ HR ] : 1.52 [ 95 % CI : 1.11 to 2.08 ] , HR : 1.70 [ 95 % CI : 0.74 to 3.88 ] , and HR : 2.81 [ 95 % CI : 0.92 to 8.84 ] , respectively ; p trend = 0.30 ) . Among every 1,000 persons with eGFR < 45 ml/min/1.73 m(2 ) treated for 3.8 years , 76 major cardiovascular events and 54 all-cause deaths will be prevented while 27 excess major bleeds will occur . CONCLUSIONS Aspirin therapy produces greater absolute reduction in major cardiovascular events and mortality in hypertensive patients with CKD than with normal kidney function . An increased risk of major bleeding appears to be outweighed by the substantial benefits A six year r and omised trial was conducted among 5139 apparently healthy male doctors to see whether 500 mg aspirin daily would reduce the incidence of and mortality from stroke , myocardial infa rct ion , or other vascular conditions . Though total mortality was 10 % lower in the treated than control group , this difference was not statistically significant and chiefly involved diseases other than stroke or myocardial infa rct ion . Likewise , there was no significant difference in the incidence of non-fatal myocardial infa rct ion or stroke — indeed , disabling strokes were somewhat commoner among those allocated aspirin . The lower confidence limit for the effect of aspirin on non-fatal stroke or myocardial infa rct ion , however , was a substantial 25 % reduction . Migraine and certain types of musculoskeletal pain were reported significantly less often in the treated than control group , but as the control group was not given a placebo the relevance of these findings was difficult to assess . There was no apparent reduction in the incidence of cataract in the treated group . The lack of any apparent reduction in disabling stroke or vascular death contrasts with the established value of antiplatelet treatment after occlusive vascular disease Background Patients with chronic kidney disease ( CKD ) are at high risk for developing cardiovascular events . However , limited evidence is available regarding the use of aspirin in CKD patients to decrease cardiovascular risk and to slow renal disease progression . Study Design Prospect i ve , multicenter , open-label r and omized controlled trial . Setting and Participants One hundred eleven patients with estimated glomerular filtration rate ( eGFR ) 15–60 ml/min/1.73 m2 without previous cardiovascular events . InterventionAspirin treatment ( 100 mg/day ) ( n = 50 ) or usual therapy ( n = 61 ) . Mean follow-up time was 64.8 ± 16.4 months . Outcomes The primary endpoint was composed of cardiovascular death , acute coronary syndrome ( nonfatal MI , coronary revascularization , or unstable angina pectoris ) , cerebrovascular disease , heart failure , or nonfatal peripheral arterial disease . Secondary endpoints were fatal and nonfatal coronary events , renal events ( defined as 
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There was also no significant reduction in cardiovascular mortality and all-cause mortality .
Our review indicated that  aspirin use in CKD patients had no prevention effect on cardiovascular events and no statistically significant reduction in risk of cardiovascular or all-cause mortality , with a significant increased risk of minor bleeding and renal events