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Kidney Week

Abstract: TH-OR05

Proton Pump Inhibitor Exposure and Risk of AKI after Cardiac Surgery

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Koh, Hee Byung, Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)
  • Joo, Young Su, Division of Nephrology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (the Republic of)
  • Kim, Hyung Woo, Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)
  • Jo, Wonji, Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)
  • Kang, Shinchan, Division of Nephrology, Department of Internal Medicine, Uijeongbu Eulji University Medical Center, Uijeongbu, Korea (the Republic of)
  • Jhee, Jong Hyun, Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  • Han, Seung Hyeok, Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)
  • Yoo, Tae-Hyun, Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)
  • Kang, Shin-Wook, Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)
  • Park, Jung Tak, Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)
Background

Although postoperative acute kidney injury (AKI) is a serious and common complication of cardiac surgery, strategies for prevention are limited. A close link between proton pump inhibitor (PPI) usage and chronic kidney disease has been recently proposed. Therefore, the association between PPI exposure and AKI development after cardiac surgery was evaluated.

Methods

This retrospective study was conducted by analyzing two cohorts based on tertiary hospital-based electronic medical records and nationwide health insurance information. The Severance cardiac surgery cohort consisted of 6,555 patients aged ≥18 years who underwent cardiac surgery between May 2011 and September 2020. From the National Health Insurance Service-senior (NHIS-senior) cohort, 2,939 patients aged ≥60 years who underwent cardiac surgery between 2004 and 2015 were selected. Preoperative PPI exposure was defined as a PPI prescription record within 3 weeks before cardiac surgery. Primary outcome was AKI requiring dialysis (AKI-dialysis) and secondary outcomes were in-hospital mortality and hospital and intensive care unit (ICU) stay durations.

Results

In the Severance cardiac surgery cohort (mean age, 62.0 years; male, 60.1%) after propensity score matching, incident AKI-dialysis (5.5% vs. 3.2%, P = 0.002) and in-hospital mortality (4.7% vs. 3.2%, P = 0.038) were significantly higher among PPI-exposed than PPI non-exposed patients. In addition, median (IQR) hospital (17.0 [12.0-27.0] vs. 14.0 [11.0-19.0], P < 0.001) and ICU (3.0 [2.0-5.0] vs. [2.0-4.0], P < 0.001) stay durations were longer in patients exposed to PPI than in those who were not. Multivariable conditional logistic analyses revealed that PPI exposure was significantly associated with incident AKI-dialysis (OR, 2.20; 95% CI, 1.40-3.46) and in-hospital mortality (OR, 1.53; 95% CI, 1.03-2.27). The NHIS-senior cohort (mean age, 72.4 years; male, 58.7%) revealed comparable findings, showing that PPI exposure was significantly associated with incident AKI-dialysis (OR, 2.29; 95% CI, 1.60-3.29) and in-hospital mortality (OR, 2.25; 95% CI, 1.46-3.45).

Conclusion

Preoperative PPI exposure was associated with incident AKI in patients undergoing cardiac surgery, suggesting that PPI exposure could be a modifiable risk factor for AKI in these patients.