In this episode, I’ll discuss the association of long-term proton pump inhibitor use with adverse events in patients with chronic kidney disease.
Proton pump inhibitors have many important indications, but they are also notorious for sticking around on a patient’s medication regimen long after their indication for use has vanished. The idea of PPI stewardship is to scrutinize the appropriateness of a PPI in a patient’s medication regimen and to discontinue it when no longer needed in order to avoid adverse effects from unnecessary long-term use. Such adverse events include pneumonia, fracture, and even the development of type 2 diabetes and end-stage kidney disease.
While PPI-related adverse effects are well documented in the general population, evidence that describes these adverse effects in patients with chronic kidney disease is limited. Therefore a group of authors published in Pharmacotherapy a retrospective cohort study looking at the Association of Pneumonia, Fracture, Metabolic, and Renal Events With Long-Term Proton Pump Inhibitor Use in Patients With Chronic Kidney Disease.
Data from nearly 400,000 patients in a Taiwanese research database were analyzed. About 50% of this cohort was excluded since they already had type 2 diabetes. Of the remaining patients in the cohort, the incidence of adverse events in patients with long-term PPI use when compared to the no-PPi group was as follows:
Long-term PPI use was associated with increased risk of hospitalization for pneumonia with an adjusted hazard ratio of 1.9.
Long-term PPI use was associated with increased risk of hospitalization for fracture with an adjusted hazard ratio of 2.6.
Long-term PPI use was associated with the development of type 2 diabetes with an adjusted hazard ratio of 2.
Long-term PPI use was associated with progression to end-stage kidney disease with an adjusted hazard ratio of 1.7.
All of these adverse events also had an increased chance to occur with short-term PPI use, but the adjusted hazard ratios were much smaller, around 1.09 to 1.2.
These increased risks of adverse events remained statistically significant after adjustment for significant baseline variables.
The authors concluded:
PPI use is associated with an increased risk of pneumonia, fracture, incidence of type 2 DM, and progression to ESKD in patients with CKD, and the risk increases substantially with increased duration of PPI use.
This study represents important information related to PPI use in the subgroup of patients with chronic kidney disease. While reducing unnecessary PPI use through PPI stewardship or other means always makes sense, patients with CKD may represent a cohort of patients that deserve extra focus to prevent these adverse events.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
I hope we get more of these types of articles related to internal medicine and family practice