Proton pump inhibitor use increases the risk of peritonitis in peritoneal dialysis patients.

Sayaka Maeda,Hironobu Nobata,Makoto Yamaguchi,Naoki Izumi,Yasuhiko Ito,Takayuki Katsuno,Naoto Kobayashi,Wataru Ohashi,Masaaki Nagai,Kunihiro Maeda,Takaaki Obayashi,Hideharu Abe

doi:10.1371/journal.pone.0224859

Abstract

Peritonitis is a major and the most significant complication of peritoneal dialysis (PD). Although some predictors of peritonitis in PD patients are known, the association between proton pump inhibitor (PPI) use and peritonitis has not been characterized. Here, we examined whether PPI use is a risk factor for the development of peritonitis, based on a single-center retrospective analysis of 230 consecutive Japanese PD patients at Narita Memorial Hospital. We assessed the association between PPI use and subsequent first episode of peritonitis using multivariate Cox proportional hazards models, following adjustment for clinically relevant factors. The median follow-up period was 36 months (interquartile range, 19-57 months). In total, 86 patients (37.4%) developed peritonitis. Analysis with multivariate Cox proportional hazards models revealed the following significant predictors of peritonitis: PPI use (adjusted hazard ratio [HR] = 1.72, 95% confidence interval [CI]: 1.11-2.66; P = 0.016) and low serum albumin level (per g/dl adjusted HR = 0.59, 95% CI: 0.39-0.90; P = 0.014). Thus, PPI use was independently associated with PD-related peritonitis. The results suggest that nephrology physicians should exercise caution when prescribing PPIs for PD patients.

Highlights

Peritonitis is a major and the most significant complication of peritoneal dialysis (PD), which is associated with significant morbidity, catheter loss, transfer to hemodialysis, and permanent membrane damage, and occasionally death [1]
Zhong et al reported a meta-analysis showing a significant association between H2-receptor antagonist (H2RA) use and “enteric peritonitis”; peritonitis was caused by enteric bacteria, but pump inhibitor (PPI) use was not identified as a risk factor [15]
Culture-negative peritonitis was observed in 29 (33.7%) patients, including (34.2%) patients from the PPI group and (33.3%) from the non-PPI group. In this retrospective single center cohort of 230 consecutive Japanese PD patients, we evaluated the association of PPI use and peritonitis

Summary

Introduction

Peritonitis is a major and the most significant complication of peritoneal dialysis (PD), which is associated with significant morbidity, catheter loss, transfer to hemodialysis, and permanent membrane damage, and occasionally death [1]. It is important to prevent and reduce the risk for developing peritonitis in patients on PD. Important modifiable risk factors, such as recent invasive procedures (colonoscopy, sigmoidoscopy, cystoscopy, hysteroscopy), nasal Staphylococcus aureus carriage, and exit-site and/or tunnel infections [2,3,4,5] have been identified; in addition to these risk factors, constipation, smoking, domestic pets, obesity, depression, hypokalemia, and hypoalbuminemia have been shown as predictors of peritonitis [6,7,8,9]. PPI use increases peritonitis risk in PD patients

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