Objective: To evaluate the association of preoperative proton pump inhibitor (PPI) exposure with incident acute kidney injury (AKI) after cardiac surgery. Patients and Methods: The Severance cardiac surgery cohort included 9860 cardiac surgery patients aged 18 years or older. The National Health Insurance Service-senior cohort included 2933 patients aged 60 years or older who underwent cardiac surgery. Preoperative PPI exposure was defined as a PPI prescription within 3 weeks prior to cardiac surgery. Primary outcomes were postoperative AKI and AKI requiring dialysis (AKI-dialysis). Results: In the Severance cardiac surgery cohort after propensity score matching for PPI exposure, incident AKI (44.0% [472 of 1073] vs 40.5% [1304 of 3219]) and AKI-dialysis (5.8% [62 of 1073] vs 3.7% [119 of 3219]) were more common in patients exposed to PPI than in those who were not. Hospital and intensive care unit stay durations were longer among PPI-exposed than PPI-nonexposed patients. Multivariable conditional logistic analyses revealed that PPI exposure was significantly associated with incident AKI (adjusted odds ratio [AOR], 1.21; 95% CI, 1.03 to 1.42; P=.02) and AKI-dialysis (AOR, 1.74; 95% CI, 1.15 to 2.63; P=.009). The National Health Insurance Service–Senior cohort had similar results, revealing a significant association between PPI exposure and incident AKI-dialysis (AOR, 1.87; 95% CI, 1.25 to 2.81; P=.003). Discontinuation of PPI prior to operation was associated with a lower odds of AKI development in both cohorts. Conclusion: Preoperative PPI exposure may be a modifiable risk factor for AKI among patients undergoing cardiac surgery.
|Number of pages||12|
|Journal||Mayo Clinic Proceedings|
|Publication status||Published - 2023 Feb|
Bibliographical noteFunding Information:
Data Sharing Statement: Study protocol—Available upon request; Statistical code—Statistical codes used for analyses are available from Dr Park (firstname.lastname@example.org). Data set—Severance cardiac surgery cohort data are not publicly available because the ownership belongs to Yonsei University Health System but would be considered upon reasonable request. NHIS-Senior cohort data are available via the Korean National Health Insurance Sharing Service. Researchers can request access through website application at https://nhiss.nhis.or.kr/bd/ay/bdaya001iv.do, Author Contributions: Dr Koh—Conceptualization, methodology, software, formal analysis, data curation, writing/original draft; Dr Joo—Methodology, software, formal analysis, data curation; Dr Kim—Software, formal analysis, data curation; Dr Jo—Conceptualization, methodology, data curation; Dr S. C. Kang—Conceptualization, software, formal analysis; Dr Jhee—Formal analysis, data curation; Dr M. Han—Methodology, software, formal analysis, supervision, writing/review and editing; Dr Lee—Methodology, software, formal analysis, supervision, writing/review and editing; Dr S. H. Han—Conceptualization, supervision, writing/review and editing; Dr Yoo—Conceptualization, supervision, writing/review and editing; Dr S.-W. Kang—Conceptualization, supervision, writing/review and editing; Dr Park—Conceptualization, methodology, supervision, writing/original draft, writing/review and editing.
© 2022 Mayo Foundation for Medical Education and Research
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