Chronic kidney disease (CKD) patients are exposed to more proton pump inhibitor (PPI)s compared to non-CKD patients

Abstract

Background: Proton pump inhibitor use is associated with incident chronic kidney disease, chronic kidney disease progression and end-stage renal disease. However, the extent of proton pump inhibitor prescriptions to chronic kidney disease patients is still unclear.

Method: In a retrospective study, we enrolled patients (>18 years old) who received proton pump inhibitor in the out-patient setting from 2014 through 2015. All data was obtained from electronical medical records of Soonchunhyang Medical Center. The prescription patterns and characteristics of proton pump inhibitors were analyzed according to individual estimated glomerular filtration rate of the patients.

Result: During the study period 178,228 patients visited the out-patient clinic. Proton pump inhibitors were prescribed to 9,109 (5.11%) patients. In our sample, 50% were females and 9.8% were chronic kidney disease (eGFR<60mL/min/1.73 m2) patients. Among the patients with chronic kidney disease, 730 (8.0%) were categorized as stage 3 or 4 and 166 (1.8%) were categorized as stage 5 or end-stage renal disease. The prevalence of proton pump inhibitors prescription among chronic kidney disease patients was higher than in the non-chronic kidney disease group (p<0.001). Median duration of usage was 120 [interquartile range 63-273] days in the stage 3-4 group, 106 [56-266] days in the stage 5-end-stage renal disease group and 90 [56-176] days in the non-chronic kidney disease group. Patients in stage 3-4 group were prescribed longer duration of proton pump inhibitors than the non-chronic kidney disease group even after adjusting for age and sex (p<0.001). The main departments of medicine which prescribed proton pump inhibitors for the stage 3-4 group were gastroenterology (40.0%), cardiology (29.6%), nephrology (9.5%) and neurology (4.8%). Compared to the non-chronic kidney disease group, the stage 3-4 and stage 5-end-stage renal disease group were taking larger number of drugs simultaneously (6.90±4.17 vs4.54±2.43; p<0.001, 5.64±2.87 vs 4.54±2.34; p<0.001, respectively).

Conclusion: Chronic kidney disease patients are taking proton pump inhibitors for a much longer duration compared to non-chronic kidney disease patients. Physicians should pay careful attention when prescribing proton pump inhibitors to high risk groups.

Fig 1

Median values of total duration of PPI prescription during 2014–2015 by CKD groups (A), and duration prescribed at once by CKD groups(B). Fig 1A shows the CKD groups were prescribed significantly longer duration of PPIs than the non CKD group (p<0.001). Fig 1B shows the CKD stage5-ESRD group had significantly shorter duration of PPI prescribed at once than the other groups (p<0.001). †pair-wised comparisons were performed and p-value adjusted by bonfferoni correction.

Fig 2. Main departments prescribing PPIs.

The percent of prescriptions from the gastroenterology department gradually decreased, while percent of prescriptions from the nephrology department gradually increased as the eGFR decreased (Both p<0.001 in linear by linear association).OS, orthopedic surgery department; MN, Nephrology department; MC, Cardiology department; MG, Gastroenterology department; NR, Neurology department.