Comparison of the Safety Effects of Antiplatelets on the Kidneys in Patients with Vascular Disease

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Introduction
Non-communicable diseases (NCDs) pose a significant worldwide risk to human life, health, and sustainable development in countries with low and intermediate incomes [1,2].As per the World Health Organisation (WHO), nearly 36 million deaths occur annually due to non-communicable diseases.These diseases are caused by various

General Background
This study adopted an analytical observational approach with a retrospective cross-sectional research design.The subjects were collected using secondary medical record data and the history of drug use of vascular disease patients who received anticoagulant and antiplatelet therapy and met the inclusion criteria between January and December 2023.The used medical record data included patient identity, clinical characteristics, blood pressure, medical history, and drug use history, including the name and dosage of the drug.Subjects were used as samples for research and observed for a year.The variables that were the subject of the study were parameters of decreased kidney function and the occurrence of vascular disease.Observed cases of vascular disease included hypertension, stroke, congestive heart failure, atherosclerosis, and diabetes mellitus.The study has limited time scope because it can't track the history of anti-platelet users any further and cannot track the patient's future development from the time of the study.

Sample / Participants / Group
The inclusion criteria consisted of adults aged over 18 who have been diagnosed with vascular disease, as described previously, and are undergoing anticoagulant and antiplatelet therapy while also undergoing a comprehensive blood test.Patients with incomplete medical records, those who passed away prior to the conclusion of the monitoring period, pregnant women, patients undergoing kidney transplantation or having late-stage kidney disease during the sampling period, patients diagnosed with cancer, or those undergoing chemotherapy are excluded from the study.The sampling technique was carried out purposefully based on the calculation of the population suffering from vascular disease in the province of South Sulawesi.142 patients were chosen.The total sample included in this study was 89 patients.The group of anticoagulants used in the study was clopidogrel, while the group of antiplatelet drugs used in this study was acetylsalicylic acid.

Data Analysis
The data analysis was statistically performed using bivariate and multivariate analysis to compare variable significance in statistical terms so that meaningful comparisons could be obtained between the two compared anticoagulant and antiplatelet drugs.In bivariate analysis, the chi-square analysis method was used to analyse the nominal data of the relationship between clopidogrel and salicylic acetylic acid use in renal patients with vascular disease.In addition, chi-square analysis was applied to the analysis of role variables such as gender, age, and comorbidity.

Research
The vascular disease patients included in the study are presented in table I. 47% of patients are male, and 53% are female.The gender and age characteristics of patients in both groups of studies found no statistically significant differences (p>0,05).The presentation of clopidogrel patients in this study was 18 patients, while the presentation of aspirin patients was 71 patients.As for vascular disease patients using clopidogrel therapy, with high blood pressure patients were predominantly presented at 33%, followed by congestive heart disease patients at 27%.Meanwhile, vascular disease patients using aspirin anti-platelet therapy were dominated by patients with congestible heart disease, with a presentase of 32%, following hypertensive patients at 31%.The analysis of treatment characteristics for patients with vascular diseases, considered one of the dependent variables, was conducted using the bivariate chi-square method.Vascular disease patients with clopidogrel therapy in Ibnu Sina Makassar Hospital and in RSUD Labuang Baji Makassar ranged from 17 to 71 patients, with a long majority of therapy over 7 days.Vascular disease patients in this study generally received several therapies in addition to anticoagulants and antiplatelet inhibitors, namely beta, CCB dihydropyridine, digoxin, statins, metformin, sulfonylurea, proton pump inhibitors (PPI), insulin, diuretics, amiodaron, and anticholesterol drugs.In addition, vascular disease patients receiving clopidogrel and acetylsalicylic acid therapy were dominated by patients with a history of cardiovascular disease ranging from 84 people.
Using a multivariate analysis with a sample significance threshold of 5%, the multivariate analysis examines the impact of the glomerulus and creatinine filtering the rate variables as indicators of kidney injury.If there was a significant difference between the variables based on kidney loss (p value < 0.05), the statistical test findings were considered meaningful or connected.The outcomes of the study's multivariat analysis are as follows.In the multivariate analysis, the influence of the glomerulus and creatinine filtering rate variables as parameters of kidney damage was analysed using a multivariate analysis with a sample significance level of 5%.The statistical test results were stated to be meaningful or related if the p value <0.05 means there was a significant difference between the variables depending on kidney loss.According to the table 2, 71 patients were treated with aspirin, 50 of whom were indicated to have reduced kidney function characterised by glomerulus filtration rate < 60 (mg/dL).Meanwhile, 17 patients received clopidogrel therapy, 14 had reduced renal function.In the statistical analysis of multivariate it is known that the p-value value (p > 0,05) means no significant or significant difference between the therapeutic characteristics of either patient therapy therapy clopidogrel and salicylic acetylic acid treatment of patients against the rate of glomerulus and serum creatinine filtration as one of the parameters of kidney damage.According to a cohort study of the clinical picture of the kidney of a vascular patient conducted by Chiu, showing that the use of NSAIDs may increase the risk of kidney disease in elderly patients and comorbid chronic disease, regardless of its class and selectivity in the treatment of vascular disease [8].The study analysed the influence of the history of the disease on the rate of glomerulus and creatinine filtration with a multivariate analysis to evidence if there was an influence on the glomerulus filtration rate.According to table 2, 82 patients with a history of cardiovascular disease, 62 of whom were indicated to have reduced kidney function with a glomerulus filtration rate of < 60 (mg/dL).Meanwhile, 4 patients with concomitant non-cardiovascultural disease, 2 of them indicated a reduced renal function.In the multivariate analysis it was stated that the p-value (p > 0.05) means no significant or significant difference between the history of comorbid disease of the patient with respect to the rate of glomerulus filtration and serum creatinine of the vascular patient at Ibnu Sina Hospital and RSUD Labuang Baji Makassar.Patient with uncontrol blood pressure having indicated for reduce GFR like statistical result showed p-value 0.006.This is because constriction in the afferent renal arteriole can lead to increased pressure, potentially reducing blood supply to the glomerulus.
It was observed that patients with unhealthy lifestyles, such as alcohol and cigarette consumption, are at risk of experiencing a reduction in GFR.The data indicate that patients with such lifestyles are more likely to experience a decrease in GFR.Patient with history using drug induced renal failure like diuretic, sulfonylurea, CCB, and statin have potentially risk compared to just using antiplatelet, and we can see with analytic p-value 0.03.Patient with comorbid hypertension, CHF, and stroke is more have risk occur Disorders of data connectivity mainly to the kidneys, so when compared to the use of drugs, the disease is more likely to cause renal disorders.

Discussion
In studies examining the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on kidney function, it has been found that NSAID users who undergo longer treatment durations face an elevated risk of kidney disorders.Moreover, this risk is heightened in patients with a history of renal failure [18,19].Therefore, the study undertook an analysis of the long-term impact of therapy and the utilization of treatment regimens on glomerular filtration rate and serum creatinine levels through multivariate analysis.This aimed to determine whether there was a sustained effect of treatment and medication usage on kidney damage parameters [20,21,22].
During the treatment period of less than 7 days of 29 patients, 24 of whom were indicated to have reduced kidney function characterised by glomerulus filtration rate < 60 (mg/dL).The multivariate test results showed a p-value of (p > 0.05) which means that there was no significant influence between the duration of therapy on the rate of glomerular filtration and the serum creatinine of the vascular patient.In the use of therapeutic therapy, the results of multivariate analysis showed a p-value of (p > 0.05) which means that there was no significant influence between the history of drug use on the rate of glomerulus filtration and vascular creatinine of the patient.Study data on chronic kidney failure patients treated in RSUP hospital Prof. Dr. R. D. Kandou Manado showed that 52% of patients were active smokers.Smoking has been proven based on several statistical trials to have a significant link to the incidence of chronic kidney failure.A study conducted on the analysis of risk factors for chronic kidney failure in the hemodialysis unit of Dr. Moerwadi Hospital showed data that there was a significant relationship between the history of smoking and the incidence of chronic renal failure.Therefore, an analysis of life patterns such as smoking and alcohol consumption on glomerular filtration rates was carried out with crosstab and chi square analysis to find out if there was an influence of non-living pattern on the glomerulus filtration rate.It is known that 86 patients with a lifestyle that is not at risk of kidney disease, 63 of whom were indicated to have reduced kidney function characterised by glomerulus filtration rate < 60 (mg/dL).The multivariate test results showed a p-value of (p > 0.05) which means there was no significant influence between life patterns on the patient's vascular glomerulus filtration rate [16,20].Clopidogrel is a widely used anti-platelet drug.Clopidogrel works by blocking the P2Y12 component of the ADP receptor in the thrombocytes.It is a thrombotic aggregation inhibitor that has a good effect and is often used in patients with mild strokes to prevent strokes.Clopidogrel has a different antiplatelet effect on each patient.Clopidogrel is a slow-working product.The usual dose is 75 mg/day.The effects of Clopidogrel are visible from the first day of use to 1 year of use in reducing cerebrovascular incidence.In addition to its effective effects, Clopidogrel also causes side effects such as bleeding, discomfort in the gastrointestinal tract, diarrhoea, and rash.The oral dose of clopidogrel is 75 mg/day.The ACCF/AHA report for peripheral artery disease recommends clopidogrel as a substitute for aspirin or concomitant aspirin for those who do not experience elevated blood pressure and bleeding but are at high cardiovascular risk [8].For Stemi's disease, the initial dose of 600mg was then continued with 75 mg/day, but with the note that the 600mg dose is only given if in fibrinolytic treatment.According to research, thrombocyte inhibition with clopidogrel treatment over the last 3 months has been effective in reducing ©Copyright 2024 by the author(s) This work is licensed under a Creative Commons Attribution 4.0 International License.

Table 2 . Multivariate analysis of the relationship between the dependent variable and glomerular filtration rate.
* is indicated significant relation ©Copyright 2024 by the author(s) This work is licensed under a Creative Commons Attribution 4.0 International License.