Association Between Proton Pump Inhibitor Exposure and Acute Kidney Injury After Cardiac Surgery

Hee Byung Koh; Young Su Joo; Hyung Woo Kim; Wonji Jo; Shin Chan Kang; Jong Hyun Jhee; Minkyung Han; Myeongjee Lee; Seung Hyeok Han; Tae Hyun Yoo; Shin Wook Kang; Jung Tak Park

doi:10.1016/j.mayocp.2022.07.024

Association Between Proton Pump Inhibitor Exposure and Acute Kidney Injury After Cardiac Surgery

Hee Byung Koh, Young Su Joo, Hyung Woo Kim, Wonji Jo, Shin Chan Kang, Jong Hyun Jhee, Minkyung Han, Myeongjee Lee, Seung Hyeok Han, Tae Hyun Yoo, Shin Wook Kang, Jung Tak Park

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Pages (from-to)	266-277
Number of pages	12
Journal	Mayo Clinic Proceedings
Volume	98
Issue number	2
DOIs	https://doi.org/10.1016/j.mayocp.2022.07.024
Publication status	Published - 2023 Feb

Bibliographical note

Funding Information:
Data Sharing Statement: Study protocol—Available upon request; Statistical code—Statistical codes used for analyses are available from Dr Park (jtpark@yuhs.ac). 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.

Publisher Copyright:
© 2022 Mayo Foundation for Medical Education and Research

All Science Journal Classification (ASJC) codes

Medicine(all)

Access to Document

10.1016/j.mayocp.2022.07.024

Cite this

@article{3b35a42f551f4bfbb8bd5440a7fa5051,

title = "Association Between Proton Pump Inhibitor Exposure and Acute Kidney Injury After Cardiac Surgery",

abstract = "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.",

author = "Koh, {Hee Byung} and Joo, {Young Su} and Kim, {Hyung Woo} and Wonji Jo and {Chan Kang}, Shin and Jhee, {Jong Hyun} and Minkyung Han and Myeongjee Lee and Han, {Seung Hyeok} and Yoo, {Tae Hyun} and Kang, {Shin Wook} and Park, {Jung Tak}",

note = "Funding Information: Data Sharing Statement: Study protocol—Available upon request; Statistical code—Statistical codes used for analyses are available from Dr Park (jtpark@yuhs.ac). 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. Publisher Copyright: {\textcopyright} 2022 Mayo Foundation for Medical Education and Research",

year = "2023",

month = feb,

doi = "10.1016/j.mayocp.2022.07.024",

language = "English",

volume = "98",

pages = "266--277",

journal = "Mayo Clinic Proceedings",

issn = "0025-6196",

publisher = "Elsevier Science",

number = "2",

}

TY - JOUR

T1 - Association Between Proton Pump Inhibitor Exposure and Acute Kidney Injury After Cardiac Surgery

AU - Koh, Hee Byung

AU - Joo, Young Su

AU - Kim, Hyung Woo

AU - Jo, Wonji

AU - Chan Kang, Shin

AU - Jhee, Jong Hyun

AU - Han, Minkyung

AU - Lee, Myeongjee

AU - Han, Seung Hyeok

AU - Yoo, Tae Hyun

AU - Kang, Shin Wook

AU - Park, Jung Tak

N1 - Funding Information: Data Sharing Statement: Study protocol—Available upon request; Statistical code—Statistical codes used for analyses are available from Dr Park (jtpark@yuhs.ac). 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. Publisher Copyright: © 2022 Mayo Foundation for Medical Education and Research

PY - 2023/2

Y1 - 2023/2

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85146674151&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85146674151&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2022.07.024

DO - 10.1016/j.mayocp.2022.07.024

M3 - Article

C2 - 36737115

AN - SCOPUS:85146674151

SN - 0025-6196

VL - 98

SP - 266

EP - 277

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

IS - 2

ER -

Association Between Proton Pump Inhibitor Exposure and Acute Kidney Injury After Cardiac Surgery

Abstract

Bibliographical note

All Science Journal Classification (ASJC) codes

Access to Document

Other files and links

Fingerprint

Cite this