A recent study found that proton-pump inhibitor (PPI) use is associated with a higher mortality risk in kidney transplant recipients (KTRs).
The study involved 703 KTRs. Baseline assessments were performed between November 2008 and March 2011. Follow-up was performed for an 8.2 year-long median. The study found that the mortality risk in PPI users was increased by almost two times compared with patients who did not take PPIs. PPI use was found to be particularly associated with death from infectious diseases and cardiovascular diseases. The mortality risk was found to be the highest in KTRs taking high doses of PPIs.
“The current study highlights the importance of an evidence-based indication for PPI treatment and provides a rationale to perform a randomized controlled trial on chronic PPI therapy in KTRs,” the authors wrote about the results of the study. “Hence, physicans should deliberate whether the benefits of PPI therapy outweigh the risks for each individual patient.”
The findings were replicated in an independent cohort of 656 KTRs. This strengthened the evidence for an association between increased mortality in KTRs and PPI use. The authors stressed that further corroboration of the data is necessary, however.
“Because of the observational nature of our data, our results require further corroboration before it can be recommended to avoid the long-term use of PPIs in KTRs,” the authors wrote.
The study was published in PLOS Medicine on June 15. The study was done because chronic PPI use is common in KTRs. PPIs are often prescribed to prevent the gastrointestinal side effects that immunosuppressive medications can cause after kidney transplantation. Several previous observational studies on people from the general population and amongst patients on hemodialysis had found that PPI use was associated with a higher death rate.
Proton pump inhibitors such as Nexium, Prilosec and Prevacid have previously been linked by numerous studies to acute interstitial nephritis, a condition which is associated with kidney damage and death. A 2016 study associated a 20 to 50 percent higher risk of developing chronic kidney disease with taking two doses of Nexium every day. Another study found that people taking proton pump inhibitors had a 13.49% rate of developing acute kidney injury compared to 5.46% in a control group.
The study published on June 15 looked into whether PPI use was associated with estimated glomerular filtration rate (eGFR) decline because of the association between PPIs and acute interstitial nephritis. The study did not find an association between eGFR decline and PPI use.