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Abstract: FR-PO165

Proton Pump Inhibitor Use and Progression to Major Adverse Renal Events: A Competing Risk Analysis

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Grant, Christopher Henry, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  • Gillis, Keith, University of Glasgow, Glasgow, United Kingdom
  • Lees, Jennifer S., University of Glasgow, Glasgow, United Kingdom
  • Traynor, Jamie P., NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  • Mark, Patrick B., University of Glasgow, Glasgow, United Kingdom
  • Stevens, Kathryn K., NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
Background

Proton pump inhibitors (PPIs) are commonly prescribed in primary and secondary care. PPIs are associated with acute tubulointerstitial nephritis, but their association with chronic kidney disease (CKD) is uncertain. We aimed to determine if PPI use is associated with adverse renal outcomes or survival in patients with CKD.

Methods

We conducted a retrospective observational cohort study comprising patients with CKD attending a secondary referral renal clinic between 01/01/2006 and 31/12/2016. Baseline exposure variables at start of PPI (PPI group) or study inception (control group) were derived for relevant clinical, socio-demographic and biochemical data. The primary outcome was a composite measure of doubling baseline creatinine or end stage renal disease (ESRD) denoted Major Adverse Renal Events (MARE). We defined tubular dysfunction as potassium or magnesium below laboratory normal range. A competing risks survival analysis evaluated the association between PPI exposure and MARE, with the competing risk of death.

Results

There were 7765 patients referred to a secondary care renal clinic during the study period: 6734 were included in the analysis of which 2928 were prescribed a PPI. The PPI group had more men (51.3 vs 48.7%, p=0.04) with higher GFR (35.6 vs 32.0, p<0.001), but similar burden of cardiovascular disease (69.2 vs. 67.4, p=0.13) and diabetes (61.8 vs 63.9%, p=0.09), and the same age (68.5 vs 68.0 years, p= 0.02). There was more tubular dysfunction in the PPI group (59.2 vs. 54.2%, p<0.001). In a competing risks survival analysis, there was no difference between progression to death (p=n/s), but greater progression to MARE in the PPI group (log rank p<0.001). After adjustment for the competing risk of death, the factors associated with progression to MARE were tubular dysfunction (SHR 2.33, 95% CI 20.80-2.60, P<0.001), diabetes (SHR 1.39, 95% CI 1.26-1.54, P<0.001) and hypereosinophilia (SHR 1.71, 95% CI 1.53-1.92, P<0.001). PPI use was not associated with increased risk of progression to MARE on multivariable adjustment.

Conclusion

PPI use may not be associated with progression to MARE in patients with renal impairment. Tubular dysfunction, hypereosinophilia and diabetes were associated with MARE regardless of PPI use. Further prospective analysis is required to validate these findings