N WALIA1,2, N RAO1, M GARRETT3, K YATES3, S MALONE3, C HOLMES1,4
1Bendigo Health, Bendigo, Australia, 2Austin Health, Heidelberg, Australia, 3Home Dialysis, Bendigo Health, Bendigo, Australia, 4Monash Rural Health, Bendigo, Australia
Introduction: The use of proton-pump inhibitors (PPIs) has been associated with an increased risk of developing spontaneous bacterial peritonitis in patients with cirrhosis. Whether PPI use confers a similar risk in developing peritonitis in peritoneal dialysis (PD) patients remains unclear.
Methods: We performed a retrospective analysis on patients who were on PD for at least 12 months (n=57) at our health service between January 2010 and April 2020. We identified whether patients had used PPIs during PD and investigated whether this increased the risk of developing peritonitis. We also investigated whether baseline characteristics, including serum test results and underlying diagnoses had any effect on developing peritonitis.
Results: The median age of patients identified was 65 (SD 15, range 32-79) with a median time on PD being 29 months (SD 20, range 12-91). Of the 57 patients identified, 25 (44%) developed at least one episode of peritonitis, and 28 (49%) were on a PPI during PD. 57% of patients on PPI therapy went on to develop peritonitis, compared to just 31% of patients who had no PPI exposure (p=.047). Months on PD (p=0.026), lower serum urea at PD initiation (p=0.017) and underlying renovascular disease (p=0.003) were also identified as possible risk factors for peritonitis. Age, sex, phosphate binder use, baseline estimated glomerular filtration rate (eGFR) and serum albumin had no association with peritonitis incidence.
Conclusion: PPI use during PD may increase the risk of developing peritonitis. Due to the small number of patients in this study, and the limited number of studies investigating the effect of PPI use on PD peritonitis, further research is needed.
I graduated University of Melbourne Medical School in 2018, and completed my internship at Austin Health in 2019. I am currently in my first year of basic physician training at Austin Health. While I haven’t yet decided what I’d like to do long term, my current interests include renal medicine and critical care.