| Gastric acid suppression and the risk of enteric peritonitis in peritoneal dialysis patients. | |
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MedLine Citation:
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PMID: 18474916 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Peritonitis caused by enteric organisms in peritoneal dialysis (PD) patients is associated with greater morbidity and mortality than peritonitis with non-enteric organisms. One reported risk factor for enteric peritonitis (EP) is gastric acid suppression, with two small studies providing conflicting results. The objective of this study was to determine, using a larger patient population, whether gastric acid suppressants are associated with an increased risk of EP. Patients and METHODS: Using a single-center case-control design, information on episodes of EP occurring between 2003 and 2006 was collected. Control episodes were all non-enteric episodes of peritonitis that occurred during the same time interval. Proton pump inhibitor (PPI) or H(2)-blocker (H(2)B) use prior to development of peritonitis was documented. RESULTS: A total of 228 peritonitis episodes among 137 patients met inclusion criteria. In 32% of episodes, the causative organism was enteric. Gastric acid suppressant use was documented in 46% of episodes, with the majority on PPIs. Overall, gastric acid suppression was not associated with a higher EP risk (p = 0.17). In a post hoc analysis, PPIs were not associated with EP [odds ratio (OR) 1.3, 95% confidence interval (CI) 0.7-2.4; p = 0.42], whereas H(2)Bs were associated with a higher risk of EP (OR 2.9, 95% CI 1.1-7.7; p = 0.04), although the number of patients on H(2)Bs was small. CONCLUSION: Overall, gastric acid suppression was not associated with an increased risk of peritonitis with enteric organisms. While PPI use appears to be safe for PD patients with appropriate indications, the potential risk of EP with H(2)Bs requires further investigation. |
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Authors:
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Sharon J Nessim; George Tomlinson; Joanne M Bargman; Sarbjit Vanita Jassal |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis Volume: 28 ISSN: 0896-8608 ISO Abbreviation: Perit Dial Int Publication Date: 2008 May-Jun |
Date Detail:
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Created Date: 2008-05-13 Completed Date: 2008-10-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8904033 Medline TA: Perit Dial Int Country: Canada |
Other Details:
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Languages: eng Pagination: 246-51; discussion 236-7 Citation Subset: IM |
Affiliation:
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Division of Nephrology, University of Toronto, Toronto, Ontario, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Antacids / therapeutic use* Anti-Ulcer Agents / therapeutic use Case-Control Studies Enterobacteriaceae Infections / complications, epidemiology Female Gastric Acid / metabolism Histamine H2 Antagonists / therapeutic use Humans Kidney Failure, Chronic / complications, mortality Male Middle Aged Peritoneal Dialysis / adverse effects* Peritonitis / drug therapy*, etiology, mortality Proton Pumps Risk Factors |
| Chemical | |
Reg. No./Substance:
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0/Antacids; 0/Anti-Ulcer Agents; 0/Histamine H2 Antagonists; 0/Proton Pumps |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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