Document Detail

Gastric acid suppression and the risk of enteric peritonitis in peritoneal dialysis patients.
MedLine Citation:
PMID:  18474916     Owner:  NLM     Status:  MEDLINE    
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.
Sharon J Nessim; George Tomlinson; Joanne M Bargman; Sarbjit Vanita Jassal
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Publication Detail:
Type:  Journal Article    
Journal Detail:
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:
Created Date:  2008-05-13     Completed Date:  2008-10-28     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  8904033     Medline TA:  Perit Dial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  246-51; discussion 236-7     Citation Subset:  IM    
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MeSH Terms
Antacids / therapeutic use*
Anti-Ulcer Agents / therapeutic use
Case-Control Studies
Enterobacteriaceae Infections / complications,  epidemiology
Gastric Acid / metabolism
Histamine H2 Antagonists / therapeutic use
Kidney Failure, Chronic / complications,  mortality
Middle Aged
Peritoneal Dialysis / adverse effects*
Peritonitis / drug therapy*,  etiology,  mortality
Proton Pumps
Risk Factors
Reg. No./Substance:
0/Antacids; 0/Anti-Ulcer Agents; 0/Histamine H2 Antagonists; 0/Proton Pumps

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