PROTON PUMP INHIBITORS VS H2 ANTAGONISTS FOR STRESS ULCER PROPHYLAXIS: IS THERE A ROLE FOR NEPHROPROTECTION?

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Proton pump inhibitors (PPI) are a commonly prescribed medication for stress ulcer prophylaxis in critically ill patients. With ubiquitous nature of these prescribed medications, increasing literature is available regarding adverse effects including: increased risk of developing clostridium difficile colitis, pneumonia, chronic renal failure, interstitial nephritis, nutrient malabsorption, and osteoporosis. More recent data has also implicated proton pump inhibitors with development of acute kidney injury (AKI). In our urban level 1 trauma center, we sought to compare the risk of developing acute kidney injury between patients given H2 antagonists and PPI in elderly trauma patients. METHODS: A retrospective data analysis was performed with consecutive trauma patients over the age of 65 who were started on either PPI or H2 antagonists for stress ulcer prophylaxis. Development of AKI was based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria and documented over the course of hospitalization. Each group was also evaluated for dialysis requirement (either new-onset or pre-existing) during hospitalization. Data obtained also included Injury Severity Scale (ISS). Data were analyzed using one way ANOVA. RESULTS: 205 patients consecutive trauma patients over the age of 65 were enrolled and monitored for the development of AKI and the need for dialysis over the course of hospitalization. Compared to H2 antagonists, patients on PPI demonstrated no statistically significant difference in AKI development (26.2% vs. 18.2%, p = 0.17) or need for dialysis (4.8% vs. 4.1%, p = 0.82). No difference in ISS was noted between the two groups. CONCLUSIONS: Given the ubiquitous use of PPI, general public awareness has increased regarding potential adverse effects of this medication class. The aim of our study was to evaluate the role of PPI in comparison to H2 antagonist in the setting of acute trauma patients. Despite studies demonstrating a role for PPI in development of AKI, our study found that PPI did not inherently predispose elderly trauma patients to worsening AKI in comparison to H2 antagonists. Additionally these patient groups did not demonstrate a difference in need for dialysis (new onset or chronic). Our data suggests that in patients with a significant concurrent disease burden, the use of PPI for stress ulcer prophylaxis does not result in acute iatrogenic renal injury. CLINICAL IMPLICATIONS: PPI for stress ulcer prophylaxis does not uniquely predispose elderly trauma patients to worsening renal injury. DISCLOSURES: No relevant relationships by Krishna Akella, source=Web Response No relevant relationships by Brian Boden, source=Web Response No relevant relationships by Akella Chendrasekhar, source=Web Response No relevant relationships by Priscilla Chow, source=Web Response No relevant relationships by Kashif Hussain, source=Web Response No relevant relationships by Samer Ibrahim, source=Web Response No relevant relationships by Gunjan Joshi, source=Web Response No relevant relationships by Howard Sklarek, source=Web Response No relevant relationships by Liana Tatarian, source=Web Response No relevant relationships by Daisy Young, source=Web Response