Dr. Jon Cartu Research - The association between use of proton-pump inhibitors and excess ... - Jonathan Cartu Family Medical Clinic & Patient Care Center
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Dr. Jon Cartu Research – The association between use of proton-pump inhibitors and excess …

The association between use of proton-pump inhibitors and excess ...

Dr. Jon Cartu Research – The association between use of proton-pump inhibitors and excess …


Abstract

Author summary

1. Introduction

Renal transplantation is considered the preferred treatment for patients with end-stage renal disease, providing improved prognosis and quality of life at lower cost compared with dialysis treatment [13]. Although short-term outcomes after renal transplantation have tremendously improved over the last decades, long-term graft survival and mortality rates have shown little improvement [46]. Indeed, mortality rates in kidney transplant recipients (KTRs) are still 6 times higher than in the general population [7].

In search of modifiable risk factors of this excess mortality, iatrogenic factors should not be overlooked. In this respect, proton-pump inhibitors (PPIs) have drawn our attention. PPIs are commonly prescribed to KTRs to prevent dyspeptic symptoms and complications from immunosuppressive agents. Despite the favorable safety profile of these drugs, which are generally well tolerated, growing concern and evidence about the potential long-term complications of PPI therapy are emerging. Since the first case report of PPI induced hypomagnesemia [8], numerous observational studies have demonstrated that chronic PPI use is associated with several adverse health outcomes, including increased risk of nutrient deficiencies [915], Clostridium difficile infections [16,17], community acquired pneumonia [18], acute and chronic kidney disease [1921], and end-stage renal disease [22]. Given that KTRs are prone to nutrient deficiencies, have a high burden of premature cardiovascular morbidity, and recurrent infections due to use of immunosuppressive medication, KTRs might especially be susceptible to adverse effects of PPI use.

Recently, several observational studies have demonstrated that PPI use may be associated with an increased risk of mortality in elderly patients [2325]. Interestingly, the same prospective association between PPI use and increased mortality risk was found in a large cohort study of United States veterans [26] and in a cohort of 1,776 hemodialysis patients [27]. Whether chronic PPI use is associated…

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