S1340 Risk of Acute Interstitial Nephritis in Patients on Chronic Proton Pump Inhibitor Therapy

Abstract

INTRODUCTION: Proton pump inhibitors (PPIs) are commonly prescribed medications. Studies suggest a link between PPI use and acute interstitial nephritis (AIN), however data is limited. Our primary aim was to evaluate the prevalence of AIN in patients on chronic PPI therapy. Our secondary aim was to compare the risk of AIN in patients on PPI compared to H2 blockers and compare adverse events (AE). METHODS: We performed a retrospective analysis in the IBM Explorys database 5 (1999-2020), a pooled, national, de-identified clinical database of over 72 million patients from 26 health care networks and 300 hospitals across the United States. Patient populations were identified using SNOMED and ICD codes. PPI included were esomeprazole, omeprazole, pantoprazole and lansoprazole. The development of AIN was evaluated after at least 6 months of PPI therapy. Patients on medications commonly implicated in AIN including NSAIDs, antibiotics, loop diuretic, H2 blockers, rifampin, and allopurinol were excluded from the study if prescribed within 30 days of development of AIN. Patients with systemic lupus erythematosus, sarcoidosis, granulomatosis with polyangiitis, and Sjogren’s were also excluded. The control group was defined as patients on H2 blockers with the above exclusion criteria. AE were defined as ICU admission within 7 days, hemodialysis within 2 weeks, chronic kidney disease within 6 months, and end stage renal disease within 1 year. Odds ratios with 95% CI were calculated for risk of AIN for each PPI compared to the control group. Chi-squared test was used to compare the risk of AEs in the combined PPI group vs H2 blockers. RESULTS: The prevalence of AIN on chronic PPI therapy comprised 6.49% (n = 16130). Prevalence of AIN in lansoprazole was 28 (per 10,000), esomeprazole was 21 (per 10,000), omeprazole was 15 (per 10,000), and pantoprazole was 8 (per 10,000). Esomeprazole, omeprazole, and lansoprazole were associated with an increased risk of AIN when compared to the control. Lansoprazole had the highest associated risk for AIN (OR 2.53, 95% CI 2.38-2.70, followed by esomeprazole (OR 1.9, 95% CI 1.8-2.02), and then omeprazole (OR 1.32, 95% CI 1.26-1.39). Esomeprazole had a higher risk of ICU admission and new-onset CKD. Lansoprazole had a higher risk of ESRD. CONCLUSION: Most PPIs confer a higher risk of AIN compared to H2-blockers. Esomeprazole should be used with caution in patients at high risk for the development of CKD or ESRD. Future prospective studies are needed to validate these findings.Figure 1Figure 2