Abstract
BackgroundsProton pump inhibitors (PPIs) can be associated with vascular calcification in patients undergoing dialysis through hypomagnesemia. However, only few studies have demonstrated the influence of PPIs on vascular calcification in patients on maintenance hemodialysis (HD). This study aimed to investigate whether the use of PPIs accelerates vascular calcification in patients on HD.Materials and methodsWe retrospectively evaluated 200 HD patients who underwent regular blood tests and computed tomography (CT) between 2016 and 2017. The abdominal aortic calcification index (ACI) was measured using abdominal CT. The difference in the ACI values between 2016 and 2017 was evaluated as ΔACI. Patients were divided into PPI and non-PPI groups, and variables, such as patient background, medication, laboratory data, and ΔACI were compared. Factors independently associated with higher ΔACI progression (≥ third tertile value of ΔACI in this study) were determined using multivariate logistic regression analysis.ResultsThe PPI and non-PPI groups had 112 (56%) and 88 (44%) patients, respectively. Median and third tertile value of ΔACIs were 4.2% and 5.8%, respectively. Serum magnesium was significantly lower in the PPI (2.1 mg/dL) than in the non-PPI (2.3 mg/dL) group (P <0.001). Median ΔACI was significantly higher in the PPI (5.0%) than in the non-PPI (3.8%) group (P = 0.009). A total of 77 (39%) patients had a higher ΔACI. Multivariate analysis revealed that PPIs (odds ratio = 2.23; 95% confidence interval = 1.11–4.49), annual mean calcium phosphorus product, ACI in 2016, baseline serum magnesium levels, and HD vintage were independent factors associated with higher ΔACI progression after adjusting for confounders.ConclusionPPI use may accelerate vascular calcification in patients on HD. Further studies are necessary to elucidate their influence on vascular calcification.
Highlights
Proton pump inhibitors (PPIs) have widely been used by the general population and patients on maintenance hemodialysis (HD) as an effective treatment against peptic ulcers and gastroesophageal reflux disease [1,2,3]
Multivariate analysis revealed that PPIs, annual mean calcium phosphorus product, aortic calcification index (ACI) in 2016, baseline serum magnesium levels, and HD vintage were
PPI-induced reduction in serum Mg levels may be associated with ACI progression to some extent, our results suggested that PPIs affect vascular calcification progression in patients on maintenance HD
Summary
Proton pump inhibitors (PPIs) have widely been used by the general population and patients on maintenance hemodialysis (HD) as an effective treatment against peptic ulcers and gastroesophageal reflux disease [1,2,3]. Several studies have reported an association between long-term PPI use and hypomagnesemia [3, 4]. Hypomagnesemia is associated with more severe vascular calcification [5] and higher mortality in healthy individuals and patients on maintenance HD [6, 7]. A cross-sectional study reported the association between long-term PPI treatment and vascular calcification in patients on maintenance HD [9]. Another recent study suggested that PPIs potentially affect vascular endothelial cells [10].
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