PPI Treatment Tied to AKI After Cardiac Surgery

NEW YORK (Reuters Health) – Adults taking a proton-pump inhibitor (PPI) before cardiac surgery may be at increased risk for developing acute kidney injury (AKI), according to new research.

“Our findings suggest that PPI exposure is a modifiable risk factor for cardiac surgery-associated AKI,” lead author Dr. Hee Byung Koh of Yonsei University, in Seoul, said in a statement from the American Society of Nephrology (ASN) Kidney Week, where he presented the study.

Episodes of acute intestinal nephritis are known to be increased with PPI exposure and it’s recently been reported that the incidence of chronic kidney disease is significantly higher among PPI users than non-users. But the relationship of PPI use with AKI is not well established, he explained.

To investigate, the researchers analyzed data from the Severance cardiac-surgery cohort with 6,555 adults who underwent cardiac surgery between 2011 and 2020 and the National Health Insurance Service-senior cohort with 2,939 older adults who underwent cardiac surgery between 2004 and 2015.

Pre-surgery PPI use was defined as receipt of a PPI prescription within three weeks of cardiac surgery.

In the Severance cohort, the rate of AKI requiring dialysis was 5.5% in PPI users versus 3.2% in non-PPI users and in-hospital death rates were 4.7% and 3.2%, respectively.

After adjusting for confounding factors, PPI use was associated with 2.2-fold higher odds of developing AKI requiring dialysis and 1.53-fold higher odds of dying during hospitalization.

Findings were similar in the other cohort, with PPI use linked with 2.29-fold higher odds of AKI needing dialysis and 2.25-fold higher odds of in-hospital mortality.

These findings suggest that “stopping PPI before surgery may be a preventive strategy for AKI after cardiac surgery,” Dr. Koh said in the statement.

SOURCE: https://bit.ly/3CUIO6m Kidney Week 2021, held November 4-7, 2021.

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