Effect of gastric acid suppressants and prokinetics on peritoneal dialysis-related peritonitis

Abstract

AIM:To investigate the effect of gastric acid suppressants and prokinetics on peritonitis development in peritoneal dialysis (PD) patients. METHODS:This was a single-center, retrospective study. The medical records of 398 PD patients were collected from January 2000 to September 2012 and analyzed to compare patients with at least one episode of peritonitis (peritonitis group, group A) to patients who never had peritonitis (no peritonitis group, group B). All peritonitis episodes were analyzed to compare peritonitis caused by enteric organisms and peritonitis caused by non-enteric organisms. RESULTS:Among the 120 patients who met the inclusion criteria, 61 patients had at least one episode of peritonitis and 59 patients never experienced peritonitis. Twenty-four of 61 patients (39.3%) in group A and 15 of 59 patients (25.4%) in group B used gastric acid suppressants. Only the use of H2-blocker (H2B) was associated with an increased risk of PD-related peritonitis; the use of proton pump inhibitors, other antacids, and prokinetics was not found to be a significant risk factor for PD-related peritonitis. A total of 81 episodes of peritonitis were divided into enteric peritonitis (EP) or non-enteric peritonitis, depending on the causative organism, and gastric acid suppressants and prokinetics did not increase the risk of EP in PD patients. CONCLUSION:The use of H2B showed a trend for an increased risk of overall PD-related peritonitis, although further studies are required to clarify the effects of drugs on PD-related peritonitis.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Proton pump inhibitors; Histamine 2 receptor antagonists; Gastrointestinal motility; Peritoneal dialysis; PeritonitisCore tip: Bacterial overgrowth/proliferation in an intraluminal environment with a high pH is a well-recognized mechanism for peritonitis development, especially in liver cirrhosis patients. Several studies have investigated whether this mechanism causes peritoneal dialysis (PD)-related peritonitis, although conflicting results have been obtained for the association between acid suppressive therapy and PD-related peritonitis. In addition, no study was conducted to evaluate the association between prokinetics and PD-related peritonitis. Therefore, we sought to assess the effect of gastric acid suppressants and prokinetics on PD-related peritonitis. In the present study, H2B use, but not proton pump inhibitor use, was identified as an independent risk factor for PD-related peritonitis development. RETROSPECTIVE STUDYKwon JE, Koh SJ, Chun J, Kim JW, Kim BG, Lee KL, Im JP, Kim JS, Jung HC. Effect of gastric acid suppressants and prokinetics on peritoneal dialysis-related peritonitis. World J Gastroenterol 2014; 20(25): 8187-8194 Available from: URL:

Inhibition of Gastric Acid Secretion by H2 Receptor Antagonists Associates a Definite Risk of Enteric Peritonitis and Infectious Mortality in Patients Treated with Peritoneal Dialysis

“…The results of our study appear to support previous reports [ 21 , 22 ], suggesting that any association between treatment with IGAS and peritoneal infections in PD patients may be largely restricted to patients treated with H2A, while the evidence linking treatment with PPI and these infections was much less consistent. At first sight, this difference is difficult to explain, because both types of IGAS appear to carry similar side effects predisposing to infection.…”

“…Treatment with IGAS did not make any difference among groups, although stratified analyses disclosed a trends to an association between H2A therapy and infections by enteric microbia. A more recent case-control analysis on 120 patients [ 22 ] suggested an increased incidence of peritonitis (overall), but not of enteric peritonitis, among patients treated with H2A.…”

“…It is possible that treatment with H2A may associate unidentified, additional risks not present in the case of PPI. For instance, Kwon et al [ 22 ] have suggested that the prolonged half-life of H2A, but not of PPI, in the presence of CKD [ 23 ] could promote some of the negative effects of these drugs, in this setting.…”

Use of gastric-acid suppressants may be a risk factor for enteric peritonitis in patients undergoing peritoneal dialysis: A meta-analysis

“…Enteric peritonitis may be caused by a change in the composition and function of gut microbiota due to small intestinal bacterial overgrowth (SIBO) and a reduction in the number of butyrate‐producing bacteria, which can reduce microbial translocation, upon GAS use . However, other studies have suggested that GAS intake is not associated with an increased risk of enteric peritonitis . GASs are used commonly in ESRD patients, and the outcome of PD‐related enteric peritonitis is poor, leading to a high prevalence of catheter removal, transfer to permanent haemodialysis and death .…”

“…21,22 However, other studies have suggested that GAS intake is not associated with an increased risk of enteric peritonitis. 19,[23][24][25] GASs are used commonly in ESRD patients, and the outcome of PD-related enteric peritonitis is poor, leading to a high prevalence of catheter removal, transfer to permanent haemodialysis and death. 26 Hence, it is imperative to ascertain whether GAS intake can increase the risk of enteric peritonitis in these patients.…”