CKD Patients Use Proton Pump Inhibitors Longer

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Researchers find that physicians prescribe much longer courses of PPI therapy to patients with vs without CKD, despite the potential nephrotoxic effects.
Researchers find that physicians prescribe much longer courses of PPI therapy to patients with vs without CKD, despite the potential nephrotoxic effects.

Proton pump inhibitor (PPI) duration of use is longer among patients with than without chronic kidney disease (CKD), a study suggests.

In a study of 178,228 patients receiving care at a hospital outpatient clinic, investigators found that the median duration of PPI use was 120 days and 106 days among patients with CKD stages 3–4 and CKD stage 5 or end-stage renal disease, respectively, compared with 90 days among non-CKD group patient, Hee Jeong Lee, MD, of Soonchunhyang University Seoul Hospital, Seoul, Korea, and colleagues reported online in PLoS One.

Patients in CKD stage 3–4 group were prescribed longer duration of PPIs than the non-CKD group even after adjusting for age and sex.

The authors concluded that physicians prescribe much longer durations of PPIs to patients with CKD stage 3–4 despite the drugs' potential nephrotoxic effects. “Every medication should be cautiously considered for side or unexpected effects to reduce progression of underlying diseases such as CKD,” they wrote. “Physicians should pay attention to and consider appropriate indications when prescribing PPIs to CKD patients, especially patients at high risk for aggravation of renal impairment.”

Of the 178,228 patients, 5,874 (3.29%) had CKD and PPIs were prescribed to 9,109 patients (5.11%). PPIs were prescribed to 730 patients with CKD (12.4%).

The main hospital departments that prescribed PPIs for patients with CKD stage 3–4 were gastroenterology (40.0%) and cardiology (29.6%), the investigators reported. Nephrologists and gastroenterologists were the main prescribers of PPIs for patients in the CKD stage 5-ESRD group.

Reference:

Lee HJ, Lee H, Oh SH, et al. Chronic kidney disease (CKD) patients are exposed to more proton pump inhibitors (PPI)s compared to non-CKD patients. PLoS One. 2018. 13(9):e0203878

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