Chronic kidney disease (CKD) patients are exposed to more proton pump inhibitor (PPI)s compared to non-CKD patients

Lee, Hee Jeong; Lee, Haekyung; Oh, Song Hee; Park, Joonbyung; Park, Suyeon; Jeon, Jin Seok; Noh, Hyunjin; Han, Dong Cheol; Kwon, Soon Hyo

doi:10.1371/journal.pone.0203878

Cited by 22 publications

(28 citation statements)

References 25 publications

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“…It is nearly similar to Lee et al who observed 7.1% patients with CKD stage 3-4 and 6.6% pts with CKD-5 end stage renal diseases ware using NSAIDs. 15 Santra et al also found that 58% patients were on AMA while 30% patients were on NSAIDs, this is very high as compared with our study. But there are very less studies on the drug utilization in chronic kidney disease patients.…”

Section: Discussionsupporting

confidence: 54%

“…13 In study done by Lee et al observed that CKD patients are taking PPI for a much longer duration compared to non-CKD patients (range 63-273 days vs 56-176 days respectively). 15 In another study of Erdem et al patients with haemodialysis were using PPIs for average of 42.5±35 months (range 3-144 months) which is very high. 14 But it may be harmful because by the Sampathkumar et al the average age of PPI induced AIN was 52.5±18 years while duration of PPI consumption before diagnosis of AIN was 1-8 weeks.…”

Section: Discussionmentioning

confidence: 92%

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Use of proton pump inhibitors in dialysis unit in tertiary care hospital: a pharmaco-epidemiological study

Pendhari¹,

Joshi²,

Limaye³

2021

Int J Basic Clin Pharmacol

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Background: Proton pump inhibitors (PPI) are generally thought to be safer drug with fewer adverse effects. Though this class of the drug is thought to be well tolerated, a detail study about actual use of these agents in nephrology department is still awaited in many parts of India. There had been case reports and case series which were reporting PPIs producing acute interstitial nephritis progressing to acute renal failure. The risk of PPI treatment in haemodialysis patients remains unexplored. The aim of the study was to evaluate a drug utilization of PPI in patient undergoing haemodialysis procedure.Methods: In this study every day visit to the dialysis units of the hospitals was carried out. After taking consent from the patients, the information from the case-report form was noted like; age, sex, diagnosis, laboratory reports and drug prescried. No personally identifiable information about patient or physician was collected. After this an interview of patients was taken.Results: In this study, out of 126 patients 76.6% were male and 23.4% were female. Out of these 126 patients 88.89% patients were on PPI. Nearly 54% were using PPI for more than six months. Nearly 29% patients were using PPI for more than 12 months.Conclusions: As many case-reports and studies are suggesting, there is co-relation of PPI and acute interstitial nephritis from this study we suggest that especially in nephrology unit patients’, more caution must be exercised while using PPI.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 92%

Use of proton pump inhibitors in dialysis unit in tertiary care hospital: a pharmaco-epidemiological study

Pendhari¹,

Joshi²,

Limaye³

2021

Int J Basic Clin Pharmacol

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“…Although several studies have shown higher risks of acute kidney injury (AKI) and CKD associated with long‐term PPI use in the general population, 5–9 studies in CKD patients are rare 10 and the impact of PPIs on outcomes in this population is unclear. Several reports suggest that PPIs are prescribed more frequently in patients with than without CKD 11–13 . We hypothesized that long‐term use of PPIs may be a risk factor for AKI and disease progression to end‐stage in CKD patients.…”

Section: Introductionmentioning

confidence: 99%

Adverse outcomes of proton pump inhibitors in patients with chronic kidney disease: The CKD‐REIN cohort study

Liabeuf

Lambert

Metzger

et al. 2021

Brit J Clinical Pharma

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Aims Long‐term use of proton pump inhibitors (PPIs) has been associated with adverse kidney events in the general population, but their impact among chronic kidney disease (CKD) patients is unclear. We studied the prevalence and incidence (new users) of PPI prescriptions and their relation to kidney outcomes and mortality in CKD patients. Methods We collected drug prescriptions prospectively in a cohort of 3023 nephrology outpatients with CKD stages 2–5 at inclusion. Hazard ratios (HR, 95% confidence intervals [95% CI]) for acute kidney injury (AKI), end‐stage kidney disease (ESKD), and mortality associated with new PPI prescriptions as a time‐dependent variable were estimated with cause‐specific Cox models in 1940 non‐users with eGFR ≥ 15 mL/min/1.73 m2 at baseline, adjusted for comorbidities, laboratory data and drugs. Results There were 981/3023 (32%) prevalent users (67 ± 13 years, 65% men) at baseline, and 366/3023 (12%) were prescribed PPI (new users) over a median follow‐up of 3.9 years (interquartile range, 3–4.2). Among these new users, their median cumulative duration of prescription was 1 year (interquartile range: 0.4–2.3). During follow‐up, 354 patients developed ESKD and 216 died before ESKD. The adjusted HRs associated with PPI prescription were 1.74 (95% CI, 1.26–2.40) for ESKD and 2.42 (95% CI, 1.73–3.39) for all‐cause mortality. Over the first 3 years of follow‐up, 211 AKI events had occurred. The adjusted HR for AKI associated with PPI prescription was 2.89 (95% CI, 1.91–4.38). Conclusions Long‐term PPI prescription was common in CKD patients. Our results call attention to its potential risks of both acute and chronic kidney failure.

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“…2 The prevalence of PPI use in the chronic kidney disease (CKD) population is likely higher than for patients without CKD because some studies suggest that patients with CKD are prescribed more PPIs and for longer durations than patients without CKD. 3 PPIs are often used for indications and for lengths of time that were never tested or approved by the US Food and Drug Administration (FDA). They are frequently overprescribed, rarely deprescribed, and often initiated inappropriately during hospitalization, and their use is continued for the long term even in the absence of medical indication.…”

Section: Introductionmentioning

confidence: 99%

Proton Pump Inhibitors and the Kidney: Implications of Current Evidence for Clinical Practice and When and How to Deprescribe

Al‐Aly

Maddukuri

Xie

2020

American Journal of Kidney Diseases

101

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Proton pump inhibitors (PPIs), long thought to be safe, are associated with a number of nonkidney adverse health outcomes and several untoward kidney outcomes, including hypomagnesemia, acute kidney injury, acute interstitial nephritis, incident chronic kidney disease, kidney disease progression, kidney failure, and increased risk for all-cause mortality and mortality due to chronic kidney disease. PPIs are abundantly prescribed, rarely deprescribed, and frequently purchased over the counter. They are frequently used without medical indication, and when medically indicated, they are often used for much longer than needed. In this In Practice review, we summarize evidence linking PPI use with adverse events in general and adverse kidney outcomes in particular. We review the literature on the association of PPI use and risk for hypomagnesemia, acute kidney injury, acute interstitial nephritis, incident chronic kidney disease, kidney disease progression, end-stage kidney disease, and death. We provide an assessment of how this evidence should inform clinical practice. We review the impact of this evidence on patients' perception of risk, synthesize PPI deprescription literature, and provide our recommendations on how to approach PPI use and deprescription. Clinical VignetteA patient with a history of hypertension, congestive heart failure, and peptic ulcer disease underwent hospitalization and blood transfusion 6 months ago. He was treated with pantoprazole, 40 mg, once daily and a Helicobacter pylori eradication regimen and continued to be on pantoprazole treatment. He was admitted to the hospital from the primary care clinic following laboratory findings indicating an increase in serum creatinine (Scr) level from 1.4 to 5.4 mg/dL. During his hospital stay, Scr level continued to increase and peaked at 11 mg/dL. Workup revealed proteinuria with protein excretion of 700 mg/d, and kidney biopsy revealed diffuse acute interstitial nephritis (AIN) and acute tubular injury. Pantoprazole was suspected as the likely culprit and because he had completed more than 6 months of treatment, it was stopped. He was treated with a steroid regimen and his Scr level improved to 1.7 mg/dL.Six months after the hospitalization with AIN, the patient reported dyspepsia to his primary care physician, and treatment with oral omeprazole, 20 mg, once a day was started. On a follow-up visit, he was noted to have an Scr level of 8.6 mg/dL. He was then admitted to the hospital and underwent kidney biopsy that revealed acute-on-chronic interstitial nephritis. Omeprazole therapy was stopped, and he was treated with steroids. His kidney function partially improved with an Scr level of 3.2 mg/dL. The patient was subsequently managed with ranitidine with satisfactory symptom relief.

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Chronic kidney disease (CKD) patients are exposed to more proton pump inhibitor (PPI)s compared to non-CKD patients

Cited by 22 publications

References 25 publications

Use of proton pump inhibitors in dialysis unit in tertiary care hospital: a pharmaco-epidemiological study

Use of proton pump inhibitors in dialysis unit in tertiary care hospital: a pharmaco-epidemiological study

Adverse outcomes of proton pump inhibitors in patients with chronic kidney disease: The CKD‐REIN cohort study

Proton Pump Inhibitors and the Kidney: Implications of Current Evidence for Clinical Practice and When and How to Deprescribe

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