Abstract: SA-PO273
Proton Pump Inhibitors and Risk of Incident Nephrolithiasis: A Retrospective Cohort Study
Session Information
- Bone and Mineral Metabolism: Calcium, Magnesium, Kidney Stones
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Simonov, Michael, Yale New Haven Hospital, New Haven, Connecticut, United States
- Abel, Erica A., VA Connecticut Healthcare System, West Haven, District of Columbia, United States
- Hauser, Ronald G., Yale University School of Medicine, New Haven, Connecticut, United States
- Brandt, Cynthia A., VA Connecticut, West Haven, Connecticut, United States
- Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States
- Laine, Loren, Yale School of Medicine, New Haven, Connecticut, United States
Background
Proton pump inhibitors (PPIs) have come under scrutiny given evidence of their association with various conditions including chronic kidney disease and fracture. Biochemically, the effect of PPIs and nephrolithiasis is unclear. PPIs decrease calcium gut absorption and decrease urine calcium and oxalate, which may be protective. However PPIs also decrease urine citrate which may increase stone formation. We studied the association of incident PPI use with nephrolithiasis in a large retrospective cohort.
Methods
Setting: Data were obtained from a large patient cohort from the Veteran’s Health Administration (VHA). Data including demographics, encounters, comorbidities, medications, and laboratory values were obtained through querying the VHA system. Patients with prior nephrolithiasis or PPI usage were excluded.
Matched Cohort:
A cohort was developed with 1:1 fixed ratio matching for PPI users and non-users based on a propensity score developed from multivariate logistic regression of the patient's covariates. Kaplan-Meier survival analysis was used. Adjusted analysis was performed with Cox proportional hazards model from a robust set of covariates, including demographics, comorbidities, medications, and healthcare system interaction.
Results
Of 1,065,962 patients considered, 422,153 patients met eligibility criteria. 81,654 patients had exposure to PPIs at some point during observation.
Of the 81,654 PPI users, 92% were matched based on propensity score to a non-PPI user. Over 660,426 patient-years of observation, PPI-exposed individuals developed nephrolithiasis at a higher rate compared to PPI-unexposed (62.3 versus 43.1 per 10,000 patient-years, relative risk ratio 1.43 (95% CI 1.33-1.54)).
Under the Cox proportional hazards model PPI usage carried a hazard ratio of 1.32 (95% CI 1.23 - 1.42).
Conclusion
In our large retrospective cohort analysis, incident PPI usage was associated with a moderately increased risk of incident nephrolithiasis.
Funding
- Veterans Affairs Support