Abstract 14311: Use of Proton Pump Inhibitors Increase Adverse Cardiovascular Events in Hemodialysis Patients: Insight From the KIDS Registry

IntroductionProton pump inhibitors (PPIs) are known to increased risk of mortality and cardiovascular events in general population. PPIs are also reported to induce QT interval prolongation linked to all-cause and cardiac mortality. However, in patients with maintenance hemodialysis there has not been thoroughly investigated.MethodsWe analyzed the risk of PPIs for cardiovascular events and the relationship between PPIs and QTc interval with the database from Kagoshima Dialysis (KIDS) registry, which was a prospective, multicenter, observational study in patients with maintenance hemodialysis in Japan.ResultsA total of 531 patients were enrolled from June 2015 to December 2018. One-year follow-up data were available for 376 patients (The use of PPIs at baseline (PPI group)217 patients, and without the use of PPIs (No PPI group)159 patients). The incidence of a composite outcome (all-cause death, non-fatal myocardial infarction, or non-fatal stroke) was higher in patients with PPI group than No PPI group (15.2% vs. 4.4%; Hazard ratio (HR)3.65, 95% Confidence Interval (CI)1.61-8.23, P value0.002). In the multivariate analysis, even after adjustment for covariates, the use of PPIs was an independent risk factor of a composite outcome (HR2.38, 95% CI1.02-5.54, P value0.045). In addition, we performed propensity-score mating analysis as a sensitivity analysis, which showed the consistent result. The incidence of bleeding showed no difference between PPI group and No PPI group (15.7% vs. 11.3%; HR1.46, 95% CI0.83-2.59, P value0.19). QTc interval was significantly longer in PPI group (449.5 ± 29.4 msec. vs. 440.4 ± 25.7 msec., P value0.002). The incidence of all-cause death was associated with significantly longer QTc interval (456.0 msec. [438.5 - 478.0] vs. 443.0 msec. [428.0 - 462], P value0.04).ConclusionsThe use of PPIs in patients with maintenance hemodialysis increased mortality and cardiovascular events without decreasing the risk of bleeding. QTc interval prolongation induced by PPIs might have increased cardiovascular events. We should always consider if our patients truly need PPIs.