Use of gastric‐acid suppressants may be a risk factor for enteric peritonitis in patients undergoing peritoneal dialysis: A meta‐analysis

Summary What is known and objective Mounting evidence suggests that long‐term use of gastric‐acid suppressants (GASs) may be associated with adverse effects. Whether GAS use increases the risk of enteric peritonitis in patients undergoing peritoneal dialysis (PD) is not known. The aim of this meta‐analysis was to evaluate the association between GAS use and enteric peritonitis in PD patients. Methods We searched PubMed, Embase and Cochrane Library databases from inception to 23 January 2018 to identify eligible studies. The primary outcome was an association between GAS use and enteric peritonitis in PD patients. Results and discussion Six studies involving 829 people were included in this meta‐analysis. Pooled data showed that GAS use in PD patients was associated with an increased risk of enteric peritonitis (odds ratio [OR] = 1.27; 95% confidence interval [CI]: 1.02‐1.57, I2 = 48%). Subgroup analyses based on GAS type revealed that histamine‐2 receptor antagonists (H2RAs) might increase the risk of enteric peritonitis in PD patients (OR = 1.40; 95% CI: 1.01‐1.93; I2 = 8%), but proton pump inhibitors (PPIs) might not (1.13; 0.72‐1.77; 6; 34%). What is new and conclusion Gastric‐acid suppressants use might be a risk factor for enteric peritonitis in PD patients. In particular, H2RAs increased the risk of enteric peritonitis, but PPIs did not. Therefore, to prevent enteric peritonitis, H2RAs should probably be prescribed with caution for PD patients. Gastric‐acid suppressants (GASs) are commonly prescribed for patients with end‐stage renal disease. However, this meta‐analysis found that use of GASs in peritoneal dialysis patients was associated with an increased risk of enteric peritonitis. Thus, GASs should be prescribed with caution for peritoneal dialysis patients.