Proton pump inhibitor usage and the associated risk of pneumonia in patients with chronic kidney disease

Background: Chronic kidney disease (CKD) is a serious medical problem and public health issue in Taiwan. Gastrointestinal symptoms frequently occur in patients with CKD, and proton pump inhibitors (PPIs) have therapeutic indications for gastrointestinal disorders involving excessive acid production. However, PPIs may also increase the risk of developing pneumonia through acute and irreversible gastric acid suppression. This study aimed to characterize differences in the risk of pneumonia in patients with CKD who use PPIs. Methods: This population-based caseecontrol cohort study in Taiwan collected data from the Taiwan Health Insurance Research Database. Cases studied consisted of all patients in the database with an initial diagnosis of CKD during the 5-year period from 1997 to 2002. Each patient with CKD who used PPIs during this 5-year period was tracked to identify the occurrence of any type of pneumonia. We estimated the adjusted hazard ratios (HRs) and 95% confidence interval (95% CI) by using multiple logistic regression analysis. Results: The adjusted HR of the risk of pneumonia for patients with CKD using PPIs was 2.21 (95% CI = 1.59-3.07, p < 0.001). The risk of pneumonia was found to be positively associated with administration of PPIs. We observed a greater risk of pneumonia in patients with CKD using PPIs than in patients not using PPIs. Conclusion: Results of this study suggest that use of PPIs in CKD patients may be associated with increasing the risk of pneumonia. Physicians should exercise caution while prescribing PPIs for patients with CKD. Copyright (C) 2013, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. All rights reserved.