Proton Pump Inhibitor Usage and the Risk of Mortality in Hemodialysis Patients

Abstract

IntroductionLong-term inappropriate proton pump inhibitors use (PPIs) is a matter of concern because of the risks associated with their long-term use in older patients with chronic conditions. The risk of PPI treatment in hemodialysis patients remains unexplored.MethodsWe assessed the relationship between the use of PPIs and the risk of death in hemodialysis patients throughout a retrospective multicenter propensity score–matched study. Information about demographic, hemodialysis treatment, laboratory data, and concomitant medication was obtained from the EuCliD database (Fresenius Medical Care). We studied 1776 hemodialysis patients on PPI therapy compared to 466 patients not receiving PPIs. The resulting population comprising 2 groups of 410 matched patients was studied.ResultsPPI use was associated with hypomagnesemia (Mg <1.8 mg/dl (0.75 mmol/l); odds ratio [OR] = 2.70, 95% confidence interval [CI] = 1.38−5.27, P < 0.01). The exposure to PPIs in the full patient cohort was identified as an independent predictor for all-cause mortality in both univariate (HR = 3.16, 95% CI = 1.69–5.90, P < 0.01) and multivariate (HR = 2.70, 95% CI = 1.38–5.27, P < 0.01) Cox regression models. Moreover PPI use was identified as a predictor of CV mortality (HR = 1.51, 95% CI = 1.05−2.20, P = 0.03) Of the 820 patients matched throughout the propensity score analysis, the hazard ratios for all-cause mortality (HR = 1.412, 95% CI = 1.04–1.93, P = 0.03) and CV mortality (HR = 1.67, 95% CI = 1.03−2.71, P = 0.04) were higher among patients on PPIs versus those not on PPIs.ConclusionThe study data suggest that the PPI treatment should be regularly monitored and prescribed only when indicated.

The association between use of proton-pump inhibitors and excess mortality after kidney transplantation: A cohort study

“…Recently, several observational studies have demonstrated that PPI use may be associated with an increased risk of mortality in elderly patients [23][24][25]. Interestingly, the same prospective association between PPI use and increased mortality risk was found in a large cohort study of United States veterans [26] and in a cohort of 1,776 hemodialysis patients [27]. Whether chronic PPI use is associated with an increased risk of mortality in KTRs is currently unknown.…”

“…Several small cohort studies among institutionalized elderly and older patients recently discharged from emergeny departments also demonstrated that PPI use is associated with an increased risk of mortality [23][24][25]. In addition, PPI use was found to be an independent predictor of mortality in 1,776 hemodialysis patients (HR 2.70, 95% CI 1.38-5.27, P < 0.01) [27]. In our study, the increased risk of premature mortality associated with PPI use was higher than previously reported by Xie and colleagues [26].…”

Increased Proton Pump Inhibitors−Induced Mortality Risk in Hemodialysis Patients

“…de Francisco et al. carried out an interesting study showing an association between the use of proton pump inhibitors (PPIs) by hemodialysis patients and increased risk of all-cause and cardiovascular mortality 1 . In addition to mechanisms that may explain the relationship between the use of PPIs and the increased risk of cardiovascular mortality discussed in their article, there is now compelling evidence for an additional mechanism that should be taken into account.…”

Briefly Noted

“…A propensity score analysis found that HD patients using protein pump inhibitors (N = 410) had a 1.4‐fold higher mortality rate and a 1.7‐fold higher cardiovascular mortality rate than matched HD patients not on such therapy (N‐410). Protein pump inhibitors also were associated with hypomagnesemia (OR: 2.7) …”