Use of proton pump inhibitors in dialysis patients: a double-edged sword?

Desbuissons, Geoffroy; Mercadal, Lucile

doi:10.1007/s40620-020-00808-y

Cited by 6 publications

(5 citation statements)

References 72 publications

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“…We suggest a critical evaluation of statin treatment in dialysis patients to reduce some of the medication burden. This also may be the case for PPIs [ 45 ]. More than 50% of CKD Stage G4/G5 and transplant patients, and even >65% of dialysis patients, used a PPI in our study.…”

Section: Discussionmentioning

confidence: 98%

Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls

Oosten

Logtenberg

Hemmelder

et al. 2021

Clinical Kidney Journal

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Background This study aims to examine polypharmacy prevalence in patients with CKD stage G4/G5, and patients with kidney replacement therapy (KRT), in comparison to matched controls from the general population. Furthermore, we examine risk factors for polypharmacy and describe the most commonly dispensed medications. Methods Dutch health claims data was used to identify 3 patient groups, i.e. CKD stage G4/G5, dialysis, and kidney transplant patients. Each patient was matched to two controls based on matched for age, sex and SES score. We differentiated between all medication use and chronic medication use. Polypharmacy was defined at three levels: use of ≥ 5 medications (polypharmacy, PP), ≥10 medications (excessive polypharmacy, EPP), and ≥15 medications (hyperpolypharmacy, HPP). Results . The PP prevalence for all medication use was 87%, 93%, and 95% in CKD stage G4/G5, dialysis and kidney transplant patients, respectively. For chronic medication use this was 66%, 70%, and 75%, respectively. PP and comorbidity prevalence were higher in patients than in controls. EPP was 42 times more common in young CKD stage G4/G5 patients (aged 20-44 years) than in controls, while this ratio was 3.8 in patients ≥75 years. Older age (64-75 years and ≥75 years) was a risk factor for polypharmacy in CKD stage G4/G5 and kidney transplant patients. Dialysis patients aged ≥75 years had a lower risk of polypharmacy compared to their younger counterparts. Additional risk factors in all patients were low socioeconomic status, diabetes mellitus, vascular disease, hospitalization, and an emergency room visit. Most commonly dispensed medications were proton pump inhibitors (PPIs) and statins. Conclusion CKD stage G4/G5 patients and patients with KRT have a high medication burden, far beyond that of individuals from the general population, as a result of their kidney disease and large burden of comorbidities. A critical approach to medication prescription in general, and of specific medications like PPIs and statins (in the dialysis population), could be a first steps towards a more appropriate medication use.

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Section: Discussionmentioning

confidence: 98%

Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls

Oosten

Logtenberg

Hemmelder

et al. 2021

Clinical Kidney Journal

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show abstract

“…In addition, patients with CVD, which is a major comorbidity of CKD, receive PPIs for prophylaxis of ulcer, resulting from antiplatelet medications. Consequently, PPIs might be expected to cause adverse effects in patients with CKD [17]. On the other hand, more than half of patients received medication against GDU, which might attribute to low occurrence of GDU events in this study as compared to a previous report [29].…”

Section: Discussionmentioning

confidence: 75%

“…PPIs are widely used in patients with CKD because dose adjustment is not required in patients with abnormal kidney function [16, 17]. In addition, PPIs are used to prevent aspirin-induced gastrointestinal ulcer complications in patients with cardiovascular disease (CVD), which is commonly observed in patients with CKD.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Proton Pump Inhibitor Therapy Increases the Risk of Infection in Patients with Incident Hemodialysis

Saka,

Naruse,

Chikamatsu

et al. 2023

Nephron

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Background: Infection is one of the most common causes of death in patients with chronic kidney disease (CKD). Proton pump inhibitors (PPIs) are not only widely used in patients with CKD but also represent a known risk factor for infection in the general population. Here, we investigated associations between PPIs and infection events in patients with incident hemodialysis. Methods: We analyzed data from 485 consecutive patients with CKD who started hemodialysis at our hospital between January 2013 and December 2019. We analyzed associations between infection events and long-term (≥6 months) PPI use before and after propensity score-matched analysis. Results: Of the 485 patients, PPIs were administered to 177 patients (36.5%). During 24 months of follow-up, infection events occurred in 53 patients (29.9%) with PPIs and 40 patients (13.0%) without PPIs (p < 0.001). Patients with PPIs had a significantly higher cumulative incidence rate of infection events than those without PPIs (hazard ratio [HR] 2.13, 95% confidence interval [CI]: 1.36–3.32; p < 0.001). Even after propensity score-matched analysis (132 patients matched in each), the rate of infection events was higher for patients with PPIs (28.8% vs. 12.1%, HR 2.88, 95% CI: 1.61–5.16; p < 0.001). Similar results were obtained for severe infection events in both unmatched (14.1% vs. 4.5%, HR 2.97, 95% CI: 1.47–6.00; p = 0.002) and propensity score-matched analyses (14.4% vs. 3.8%, HR 4.54, 95% CI: 1.85–11.13; p < 0.001). Conclusions: In patients with incident hemodialysis, long-term PPI use increases the risk of infection. Clinicians should be wary of unnecessarily prolonging PPI therapy.

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“…Gastrointestinal disorders, such as gastrointestinal bleeding or GERD, are more frequently seen in dialysis patients [34]. In addition, as PPIs undergo extensive hepatic metabolism, there is no need for dose adjustment according to renal function, as there is, for example, with H2 receptor antagonists [35]. For that reason, although earlier studies have reported that overuse of PPIs is seen in hemodialysis patients, PPI prescriptions are rarely reviewed in clinical practice [36,37].…”

Section: Discussionmentioning

confidence: 99%

Proton Pump Inhibitors and Hyporesponsiveness to Erythropoiesis-Stimulating Agents in Hemodialysis Patients: Results from the Japan Dialysis Outcomes and Practice Patterns Study

Nakashima,

Miyawaki,

Komaba

et al. 2023

Am J Nephrol

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Introduction: Hyporesponsiveness to erythropoiesis stimulating agents (ESAs) is important problem in dialysis patients. While proton pump inhibitors (PPIs) may inhibit iron absorption, few studies have examined associations between PPIs and ESA-resistant anemia in hemodialysis patients. This study examined the associations between PPIs and ESA-resistant anemia in hemodialysis patients. Methods: The present study was a cross-sectional study using repeated 4-month observations, up to eight observations/patient, from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS). The primary outcome was erythropoietin resistance index (ERI). ESA dose, hemoglobin, proportion of erythropoietin-resistant anemia, transferrin saturation (TSAT), and ferritin were also examined. Linear or risk-difference regression models were used with generalized estimating equations to account for repeated measurements. Results: Of 1,644 patients, 867 patients had PPI prescriptions (52.7%). Patients prescribed PPI had higher ERI, higher ESA dose, and lower TSAT levels. Multivariable analysis for 12,048 four-month observations showed significantly greater ERI in PPI users (adjusted difference 0.95 IU/week/kg/[g/dL] [95% CI: 0.40–1.50]). Significant differences were also found in ESA dose (336 IU/week [95% CI: 70–602]) and the prevalence of erythropoietin-resistant anemia (3.9% [2.0–5.8%]) even after adjusted for TSAT and ferritin. Among possible mediators between the association of PPIs and anemia, TSAT was significantly different between PPI users and non-users (adjusted difference, −0.82% [95% CI: −1.56 to −0.07]). Conclusions: This study showed the associations between PPI and ERI, ESA dose, and TSAT in hemodialysis patients; physicians should consider anemia’s associations with PPIs in hemodialysis patients.

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Use of proton pump inhibitors in dialysis patients: a double-edged sword?

Cited by 6 publications

References 72 publications

Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls

Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls

Long-Term Proton Pump Inhibitor Therapy Increases the Risk of Infection in Patients with Incident Hemodialysis

Proton Pump Inhibitors and Hyporesponsiveness to Erythropoiesis-Stimulating Agents in Hemodialysis Patients: Results from the Japan Dialysis Outcomes and Practice Patterns Study

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