Abstract
Recently, proton pump inhibitor (PPI) intake has been linked to acute kidney injury and chronic kidney disease. The objective of this study was to assess the effect of PPIs on renal function and rejection rate in kidney transplant patients. We performed a single center, retrospective analysis of 455 patients who received a kidney transplant between May 2010 and July 2015. Median follow-up time was 3.3 years. PPI prescription was assessed in half-year intervals. Primary outcome parameters were the estimated glomerular filtration rate (eGFR), change in the eGFR, and >30% and >50% eGFR decline for different time periods (up to four years post-transplantation). Our secondary outcome parameter was occurrence of biopsy proven acute rejection (BPAR) in the first two years after transplantation. Except for >30% eGFR decline from half a year to two years post-transplantation (p = 0.044) and change in the eGFR, >30% and >50% eGFR decline showed no association with PPI intake in our patient cohort (p > 0.05). Similarly, by analyzing 158 rejection episodes, BPAR showed no correspondence with mean daily PPI intake. We conclude that prolonged PPI intake has no relevant adverse effect on kidney transplant function or rejection rates. Polypharmacy, however, remains a problem in renal transplant recipients and it is thus advisable to question the necessity of PPI prescriptions when clear indications are missing.
Highlights
With only a single transplanted kidney and oftentimes reduced renal filtration rates, kidney transplant (KTx) recipients are vulnerable to the nephrotoxic adverse effects of drugs
Recent epidemiological studies that have observed a relationship between acute kidney injury (AKI), chronic kidney disease (CKD) and proton pump inhibitor (PPI) intake have been of special interest for practitioners involved in the care of KTx patients [1,2,3,4,5]
We retrospectively evaluated if a relationship between PPI intake and renal function could be found
Summary
With only a single transplanted kidney and oftentimes reduced renal filtration rates, kidney transplant (KTx) recipients are vulnerable to the nephrotoxic adverse effects of drugs. Care is taken to avoid such drugs that could further impair kidney function. For this reason, recent epidemiological studies that have observed a relationship between acute kidney injury (AKI), chronic kidney disease (CKD) and proton pump inhibitor (PPI) intake have been of special interest for practitioners involved in the care of KTx patients [1,2,3,4,5]. Tacrolimus is known to be nephrotoxic and it is thought that interactions with PPIs may change its uptake and/or metabolism [17,18,19], potentially increasing tacrolimus blood concentration. This could be detrimental to kidney transplant function
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