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Abstract: SA-PO909

PPI Use Is Associated with Higher Prevalence of Bone Fractures and Mortality in Young Hemodialysis Patients

Session Information

  • Mineral Disease: CKD-Bone
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Mineral Disease

  • 1203 Mineral Disease: CKD-Bone


  • Fusaro, Maria, National Research Council (CNR) e Institute of Clinical Physiology (IFC), Pisa, Italy, Padua, Italy
  • Gallieni, Maurizio, Ospedale San Carlo Borromeo - ASST Santi Paolo e Carlo - University of Milano, Milano, Italy
  • D'arrigo, Graziella, Clin. Epid. and Physiopath. of Renal Dis. and Hypertens., CNR-IBIM, Reggio Calabria, Italy
  • Pitino, Annalisa, Consiglio nazionale delle ricerche (CNR), Rome, Italy
  • Aghi, Andrea, University of Padua, Padua, Italy
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • McCullough, Keith, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Tentori, Francesca, DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Tripepi, Giovanni, CNR-IBIM, Reggio Calabria, Italy

Proton pump inhibitors (PPIs) are extensively used in the general population and even more in dialysis patients. The aim of this observational study was to evaluate the association between use of PPIs and bone fractures (BFs) in hemodialysis (HD) patients enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) study.


Among 49564 (58% male) hemodialysis patients from the DOPPS dataset, 39,9% of patients received PPI treatment, aged 63.8±14.3 years, median (IQ range) dialysis duration 19 (4-55) months, BMI 25.5±5.8 Kg/m2, median follow-up time 19 months (IQR 9-27).


. In the whole study cohort, 12567 patients experienced the combined endpoint BFs/death and 7.538 patients, with available data on hip fractures (HFs) had the HFs/death outcome. A significant (P≤0.002) and inverse effect modification by age on the relationship between PPI treatment and the incidence rate of BFs and HFs was found, the effect of PPI being progressively lower from 35 years of age onwards (Fig. 1). Both crude and adjusted effect modification analyses considering the competitive risks of mortality fully confirmed these results, the effect of PPI on the combined outcomes BFs/D and HFs/D being closely and inversely dependent on age (Fig. 1).


In this study, the association between PPI use and bone fracture risk was clearly confirmed in the dialysis population especially in younger patients. In addition, we could demonstrate a combined increased risk of bone fractures and death, again higher in younger patient, indicating a remarkable and avoidable adverse effect of PPIs in this population.

Effect modification by age on PPI use