Abstract: TH-PO946

Proton Pump Inhibitors versus Histamine 2 Receptor Antagonists in Transplant Patients

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Chevarria, Julio L, Tallaght Hospital, Dublin, Ireland
  • O'Keeffe, Hannah Marie, Tallaght Hospital, Dublin, Ireland
  • Berzan, Ecaterina, Tallaght Hospital, Dublin, Ireland
  • Thompson, Neil L., Tallaght Hospital, Dublin, Ireland
  • Looney, Maura, Tallaght Hospital, Dublin, Ireland
  • Mellotte, George S., Tallaght Hospital, Dublin, Ireland
  • Wall, Catherine A., Tallaght Hospital, Dublin, Ireland
  • Lavin, Peter J., Tallaght Hospital, Dublin, Ireland
Background

Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs. It has been estimated that two-thirds of those on PPIs do not have a verified indication. Recent literature has related their use with acute and chronic renal impairment. Therefore it is important to determine if PPIs are being used appropriately. The purpose of this work was to evaluate the appropriateness of PPI use in prevalent kidney transplant patients.

Methods

We performed a cross-sectional study in prevalent transplant patients from January to December 2016. We reviewed their records during that timeframe. We recorded demographic characteristics, principal comorbidities, creatinine and CKD-EPI, PPIs or H2RAs, indication, time of use, steroid dose. For the statistical analysis we used SPSS19. We carried out descriptive and inferential analysis, accepting a p<0.05 as significant.

Results

282 patients were included. 57(20%) were on steroid free regimens and 210(69.7%) were on 5mg or less.The mean dose was 3.9mg(SD 2.1). A total of 120(42.6%) were on PPIs, 87(30.9%) on Ranitidine and 75(26.6%) on neither. The most common was Omeprazole(43.3%) followed by Lansoprazole(25.8%), and 99.03% for more than 90 days. Only 14(6.7%) had a clearly documented indication for their use.

The use of PPIs was greater in hypertensive patients(p:0.02, OR 2.05, CI 95% 1.11-3.77), older patients(56.3 vs 51.8 years, p:0.023). The use of PPIs compared to ranitidine was greater in patients with diabetes(p:0,03, OR 2.30, CI95% 1.08-4.90), older patients(56.3 vs 52.3years, p:0.04) and longer transplant vintage(11.9 vs 7.3years, p:0.01) and there was no difference in the creatinine or CKD-EPI (p:0.24) at the time of review. The use of Ranitidine over PPIs was more frequent in heavier patients(79.0 vs 73.1 Kg, p:0.04).

Conclusion

A large number of patients are being treated with PPIs or Ranitidine without a documented indication. These findings highlight the importance of evaluating appropriate therapy and recommending discontinuation if a clear indication does not exist. Reducing inappropriate prescribing of PPIs in kidney transplant patients can minimize potential for adverse events, and foster controllable cost expenditure.