Proton pump inhibitor usage is associated with higher all-cause mortality and CV events in peritoneal dialysis patients

Zeng, Yingsi; Liu, Lingling; Zhu, Liya; Zhan, Xiaojiang; Peng, Fenfen; Feng, Xiaoran; Zhou, Qian; Zhang, Yujing; Wang, Zebin; Li, Jianbo; Li, Jiao; Wen, Yan

doi:10.1080/0886022x.2022.2043903

Cited by 3 publications

(3 citation statements)

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“…37,38 PPIs were also found in vivo to affect markers of endothelial health. 38 However, confounding by indication can be a significant limitation, and the risks of peritonitis and mortality with PPI use across studies might be a marker of comorbidity and frailty among PPI users.…”

Section: Discussionmentioning

confidence: 98%

“…PPI users had a 47% higher risk of all-cause mortality and 80% more CV events. 38 The mechanism for higher risk of death and CV morbidity are poorly understood but may include occurrence of adverse effects, such as infections, osteoporosis and fractures, hypomagnesemia, or reduced efficacy of some antiplatelet therapy in the context of drug–drug interactions. 37 , 38 PPIs were also found in vivo to affect markers of endothelial health.…”

Section: Discussionmentioning

confidence: 99%

“… 38 The mechanism for higher risk of death and CV morbidity are poorly understood but may include occurrence of adverse effects, such as infections, osteoporosis and fractures, hypomagnesemia, or reduced efficacy of some antiplatelet therapy in the context of drug–drug interactions. 37 , 38 PPIs were also found in vivo to affect markers of endothelial health. 38 However, confounding by indication can be a significant limitation, and the risks of peritonitis and mortality with PPI use across studies might be a marker of comorbidity and frailty among PPI users.…”

Section: Discussionmentioning

confidence: 99%

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Gastric Acid Suppression Therapy and Its Association with Peritoneal Dialysis–Associated Peritonitis in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)

Goldman,

Zhao,

Bieber

et al. 2023

Kidney360

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Background: Peritonitis is a major peritoneal dialysis (PD) related complication. We determined whether gastric acid suppression (GAS) (proton pump inhibitor (PPI) or histamine-2 receptor antagonists (H2RA)) use was associated with all-cause and organism-specific peritonitis in PD patients. Methods: In the Peritoneal Dialysis Outcomes and Practice Patterns Study (595 facilities, 8 countries, years 2014-2022), associations between GAS use and time to first episode of all-cause peritonitis were examined using Cox proportional hazards models. The primary exposure of interest was GAS, and secondarily PPI or H2RA use. Secondary outcomes were organism-specific peritonitis, peritonitis cure rates, and death. Results: Among patients (n=23 797) at study baseline, 6020 (25.3%) used PPIs, and 1382 (5.8%) used H2RAs. Overall risks of GAS use and peritonitis risk [adjusted hazard ratio (AHR)=1.05 (95% CI 0.98-1.13)], and use of PPI [AHR 1.06 (95% CI 0.99-1.14)] or H2RA [AHR 1.02 (95% CI 0.88-1.18)] did not reach statistical significance. In organism-specific analyses, GAS users displayed higher peritonitis risks for gram-negative (AHR 1.29, 95% CI 1.05-1.57), gram-positive (AHR 1.15, 95% CI 1.01-1.31), culture-negative (AHR 1.20, 95% CI 1.01-1.42), enteric (AHR 1.23, 95% CI 1.03-1.48), and particularly Streptococcal (AHR 1.47, 95% CI 1.15-1.89) peritonitis episodes. GAS was also associated with higher overall mortality [AHR 1.13 (95% CI 1.05-1.22)]. Conclusion: The association between GAS use and peritonitis risk was weaker (HR 1.05 [0.98-1.13]) than for streptococcal (HR 1.57 [1.15-1.89]) and gram-negative (HR 1.29 [1.05-1.57]) peritonitis. A better understanding of mechanisms surrounding the differential effects of GAS subtype on peritonitis risks is needed. Clinicians should be cautious when prescribing GAS. The impact of GAS deprescribing on peritonitis risk requires further evaluation.

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Section: Discussionmentioning

confidence: 98%