Proton pump inhibitors and peritoneal dialysis-associated peritonitis: a cohort study in Newcastle, Australia

Area of Science:

• Nephrology
• Gastroenterology
• Pharmacology

Background:

• Peritoneal dialysis (PD)-associated peritonitis leads to severe complications, including hospitalization, PD cessation, and mortality.
• Proton pump inhibitors (PPIs) are frequently prescribed to dialysis patients, despite previous studies suggesting a potential link to increased peritonitis risk.

Purpose of the Study:

• To investigate the association between PPI use and the risk of overall peritonitis in patients receiving PD.
• To evaluate if PPI exposure influences the incidence of peritonitis within a specific patient cohort.

Main Methods:

• A retrospective analysis of incident PD patients from 2012 to 2021 at a single Australian center.
• Patients were categorized based on PPI exposure, and multivariate Cox proportional hazard modeling was employed to assess the impact on time to first peritonitis.
• Peritonitis rates per patient-year were compared between PPI-exposed and unexposed groups.

Main Results:

• Out of 219 patients, 94 were exposed to PPIs. Peritonitis occurred in 42.6% of the PPI group versus 44.8% of the unexposed group.
• PPI use was not significantly associated with an increased risk of time to first peritonitis (HR 0.78; P=.2).
• Exploratory analysis indicated a potential association between atherosclerotic vascular disease and peritonitis.

Conclusions:

• In this cohort, PPI use was not found to be associated with an increased risk of peritonitis.
• Further research is warranted to reconcile conflicting findings across studies and explore potential organism-specific effects of PPIs on peritonitis risk.