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Tanavij Pannoi,1,2 Chissanupong Promchai,3 Penjamaporn Apiromruck,3 Suwikran Wongpraphairot,4 Chen-Chang Yang,1,5,6 Wen-Chi Pan1,5 1International Health Program, Institute of Public Health, National Yang Ming Chiao Tung University, Taipei City, Taiwan; 2Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon-Si-Thammarat, Thailand; 3Department of Pharmacy, Songklanagarind Hospital, Prince of Songkla University, Songkla, Thailand; 4Department of Nephrology Unit, Songklanagarind Hospital, Prince of Songkla University, Songkla, Thailand; 5Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan; 6Department of Occupational Medicine and Clinical Toxicology, Taipei Veteran General Hospital, Taipei City, TaiwanCorrespondence: Wen-Chi Pan, Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, No. 155, Sec.2, Li-Nong St, Taipei City, 11221, Taiwan, Tel +886-228-267-000 #67057, Fax +886-2-28218165, Email wenchipan@nycu.edu.twPurpose: Potential adverse outcomes of Proton pump inhibitors (PPIs) have increasingly been reported. The potential risks to PPIs include hypomagnesemia and chronic kidney disease (CKD). Unlike a real-world electronic medical record (RW-EMR) with active-comparator design, claim databases and special population cohort with non-user design, using in previous studies, resulted in a wide range of strength of association with indication bias. This study aimed to measure the total effect of association between PPIs use and CKD incidence using Thai RW-EMR.Patients and Methods: A retrospective hospital-based cohort was applied into this study. Electronic medical records and administrative data of out- and inpatient were retrieved from October 1st, 2010 to September 30th, 2017. On-treatment with grace period as well as propensity score matching was used in data analysis. Cox proportional hazard models were applied to evaluate the PPIs-CKD association.Results: Of all 63,595 participants, a total of 59,477 new PPIs and 4118 Histamine 2-receptor antagonist (H2RA) users were eligible for follow-up. As compared with H2RA, the PPI users were non-elderly and more likely being female. The association of PPIs with CKD was statistically significant (adjusted hazard ratio [HR] = 3.753, 95% CI = 2.385â 5.905). The HR were not statistically different by concomitant use PPIs with NSAIDs and by medication possession ratio levels.Conclusion: The association between PPIs and CKD incidence was statistically significant in this hospital-based cohort. However, self-treatment with over-the-counter PPIs, as well as, smoking, drinking alcohol and body mass index could not be fully retrieved, affecting the estimation of treatment effect.Keywords: proton-pump inhibitors, chronic kidney disease, retrospective cohort, hospital-based medical database |
