Drug Safety

, Volume 36, Issue 8, pp 635–642

Long-Term Proton Pump Inhibitor Use is Associated with Vascular Calcification in Chronic Kidney Disease: A Cross-Sectional Study Using Propensity Score Analysis

  • Maria Fusaro
  • Marianna Noale
  • Giovanni Tripepi
  • Sandro Giannini
  • Angela D’Angelo
  • Angelo Pica
  • Lorenzo A. Calò
  • Davide Miozzo
  • Maurizio Gallieni
Original Research Article

DOI: 10.1007/s40264-013-0062-6

Cite this article as:
Fusaro, M., Noale, M., Tripepi, G. et al. Drug Saf (2013) 36: 635. doi:10.1007/s40264-013-0062-6

Abstract

Background

Proton pump inhibitors (PPIs) are a class of drugs that is extensively used for common gastrointestinal disorders and often prescribed long-term for years. Long-term PPI treatment is associated with an increased risk of fractures in the general population. Several studies have suggested a relationship between vascular calcification, which is a predictor of cardiovascular morbidity and mortality, impaired bone metabolism and fractures. In dialysis patients, vascular calcifications are widespread and are connected to bone health.

Objective

The aim of this study was to assess the association between the use of PPIs and vascular calcifications involving the aorta and iliac arteries in haemodialysis patients.

Methods

Between November 2008 and November 2009, 387 patients receiving long-term dialysis treatment (≥1 year) were enrolled in a multicentre (18 Dialysis Units), cross-sectional study. Overall, 76.2 % of patients were receiving long-term PPI treatment. The main outcome measure was calcification of the aorta and iliac arteries in relation to PPI use. Standardized radiographs were sent to the coordinating centre for centralized evaluation in duplicate by two physicians who were blind to PPI status.

Results

Arterial calcifications were significantly more common in the PPI group (p < 0.01). Also, the rates of aortic and iliac calcifications considered separately were higher (+12.2 %, p = 0.0254; and +13.6 %, p = 0.0211, respectively). After correction for the propensity score, the odds ratios [ORs] (95 % CI) related to PPI use were aorta 1.89 (1.01–3.54), p = 0.048; iliac arteries 2.27 (1.31–3.92), p = 0.003; aorta and iliac arteries 2.59 (1.48–4.53), p = 0.008. The ORs (95 % CI) related to the association of warfarin + PPI were aorta 2.19 (0.95–5.00), p = 0.06; iliac arteries 2.90 (1.07–7.86), p = 0.036; aorta and iliac arteries 2.69 (1.03–6.96), p = 0.042.

Conclusion

In haemodialysis patients, long-term treatment with PPIs, especially in the presence of warfarin treatment, is associated with vascular calcifications.

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Maria Fusaro
    • 1
  • Marianna Noale
    • 1
  • Giovanni Tripepi
    • 2
  • Sandro Giannini
    • 3
  • Angela D’Angelo
    • 4
  • Angelo Pica
    • 5
  • Lorenzo A. Calò
    • 6
  • Davide Miozzo
    • 4
  • Maurizio Gallieni
    • 7
  1. 1.Consiglio Nazionale delle Ricerche (CNR) Aging BranchInstitute of NeurosciencePaduaItaly
  2. 2.Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR, Istituto di BiomedicinaReggio CalabriaItaly
  3. 3.Department of MedicineClinica Medica 1, University of PaduaPaduaItaly
  4. 4.Nephrology UnitUniversity of PaduaPaduaItaly
  5. 5.Nephrology and Dialysis UnitOspedale Santa ChiaraTrentoItaly
  6. 6.Department of MedicineClinica Medica 4, University of Padova-Azienda Ospedaliera PadovaPaduaItaly
  7. 7.Nephrology and Dialysis UnitOspedale San Carlo BorromeoMilanItaly

Personalised recommendations