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标题： Proton Pump Inhibitors Use Is Not Associated with Peritoneal Dialysis-Related Peritonitis: A Propensity Score Analysis

讲者： Surapon Nochaiwong

单位： Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University 2) Pharmacoepidemiology and Statistics Clinics, Faculty of Pharmacy, Chiang Mai University

关键词：

gastric acid suppressants peritonitis propensity score analysis proton pump inhibitors

播放： 1652

论文摘要： Background Proton pump inhibitors (PPIs) suppress gastric acid secretion, allow bacterial colonization, and may cause intestinal bacterial overgrowth and translocation. To date, evidences have yielded inconsistent findings about the association between PPIs use and the risk of peritoneal dialysis (PD)-related peritonitis.
Objectives To investigate whether PPIs use is associated with an increased risk for PD-related peritonitis.
Methods We conducted a retrospective cohort study using the PD registry database at Kidney center, General Hospital, Chiang Mai, Thailand. Subjects were first-ever PD treatment for > 90 days, between January 2008, and December, 2014 with follow-up through December 2015. The cohort included patients aged > 18 years who started a new episode of PPIs use for > 90 days. To control for demographics comorbidities, and other potential-confounders, propensity score-adjusted and multivariable Cox proportional hazards were used to evaluate the association of PPIs use with time to first PD-related peritonitis.
Results The cohort comprised 411 PD patients, 70 (17.0%) were PPIs users. At entry, PPIs users had more history of gastrointestinal diseases in comparison with non-PPIs users. Patient were followed for a median of 18.0 months. Over half of patients, 235 (57.2%), were identified as having the first episode of PD-related peritonitis. Compared to non-PPIs users, PPIs users was not associated with a higher risk for PD-related peritonitis (propensity adjusted hazard ratio [HR] = 1.22; 95% confidence interval [CI], 0.82-1.82; P=0.332). Likewise, multivariable Cox proportional hazards regression yielded similar results (adjusted HR=1.48; 95% CI, 0.97-2.27; P=0.071). In a subgroup analysis, we did not find any effect modification by causative organisms of PD-related peritonitis.
Conclusions After adjustment for detailed clinical factors, PPIs use had a neutral association with PD-related peritonitis under most circumstances. On the basis of safety and possible concerns in specific clinical situations, a large pragmatic trials of gastric acid suppressants are needed.

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