Proton pump inhibitors and the risk of hospital-acquired acute kidney injury in children

Yanqin Li; Mengqi Xiong; Minliang Yang; Long Wang; Sheng Nie; Diankun Liu; Mingjing Pi; Aihua Zhang; Jianhua Mao; Hai-Peng Liu; Huimin Xia; Hong Xu; Zhangsuo Liu; Shipin Feng; Wei Zhou; Xuemei Liu; Yonghong Yang; Yuhong Tao; Yunlin Feng; Chunbo Chen; Mo Wang; Yan Zha; Jian-Hua Feng; Qingchu Li; Shuwang Ge; Jianghua Chen; Yongcheng He; Siyuan Teng; Chuanming Hao; Bi-Cheng Liu; Ying Tang; Wenjuan He; Fan Fan Hou; Xin Xu

doi:10.21037/atm-20-2284

Proton pump inhibitors and the risk of hospital-acquired acute kidney injury in children

Ann Transl Med. 2020 Nov;8(21):1438. doi: 10.21037/atm-20-2284.

Authors

Yanqin Li¹, Mengqi Xiong¹, Minliang Yang¹, Long Wang¹, Sheng Nie¹, Diankun Liu¹, Mingjing Pi¹, Aihua Zhang², Jianhua Mao³, Hai-Peng Liu⁴, Huimin Xia⁵, Hong Xu⁶, Zhangsuo Liu⁷, Shipin Feng⁸, Wei Zhou⁹, Xuemei Liu¹⁰, Yonghong Yang¹¹, Yuhong Tao¹², Yunlin Feng¹³, Chunbo Chen¹⁴, Mo Wang¹⁵, Yan Zha¹⁶, Jian-Hua Feng¹⁷, Qingchu Li¹⁸, Shuwang Ge¹⁹, Jianghua Chen²⁰, Yongcheng He²¹, Siyuan Teng²², Chuanming Hao²³, Bi-Cheng Liu²⁴, Ying Tang²⁵, Wenjuan He¹, Fan Fan Hou¹, Xin Xu¹

Affiliations

¹ National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
² Children's Hospital of Nanjing Medical University, Nanjing, China.
³ Children Hospital of Zhejiang University, Hangzhou, China.
⁴ Anhui Institute of Pediatric Research, Anhui Provincial Children's Hospital, Hefei, China.
⁵ Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
⁶ Children's Hospital of Fudan University, Shanghai, China.
⁷ The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁸ Chengdu Women and Children's Central Hospital, Chengdu, China.
⁹ Shanghai Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.
¹⁰ Jinan Children's Hospital, Jinan, China.
¹¹ Pediatric Medical Research Center, Gansu Province Child's Hospital, Lanzhou University Second Hospital, Lanzhou, China.
¹² West China Second University Hospital, Sichuan University, Chengdu, China.
¹³ Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
¹⁴ Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
¹⁵ Children's Hospital of Chongqing Medical University, Chongqing, China.
¹⁶ Guizhou Provincial People's Hospital, Guizhou University, Guiyang, China.
¹⁷ The Second Affiliated Hospital, Zhejiang University, Hangzhou, China.
¹⁸ Guilin Medical University Affiliated Hospital, Guilin, China.
¹⁹ Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
²⁰ Kidney Disease Center, the First Affiliated Hospital, Zhejiang University, Hangzhou, China.
²¹ Center for Nephrology and Urology Shenzhen University, the First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China.
²² The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
²³ Huashan Hospital, Fudan University, Shanghai, China.
²⁴ Institute of Nephrology, Zhong Da Hospital, Nanjing, China.
²⁵ Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.

Abstract

Background: To evaluate the association between use of proton pump inhibitor (PPI) and the risk of hospital-acquired acute kidney injury (HA-AKI) in hospitalized children.

Methods: We conducted a multicenter retrospective cohort study in hospitalized children aged 1 month to 18 years from 25 tertiary hospitals across China from 2013 to 2015. Patient-level data were obtained from the electronic hospitalization databases. AKI was defined and staged using the serum creatinine (SCr) data according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.

Results: Among 42,232 children analyzed, 11,496 (27.2%) used PPI, 1,760 (4.2%) used histamine 2 receptor antagonist (H2RA), and 3,514 (8.3%) had HA-AKI during hospitalization. Over 85% of PPIs were prescribed for prophylaxis of gastro-duodenal lesions in children. The use of PPI was associated with a significantly increased risk of HA-AKI compared with both non-users [odds ratio (OR), 1.37; 95% confidence interval (CI), 1.23-1.53)] and H2RA users (OR, 1.24; 95% CI, 1.01-1.52). The associations were consistent across children of different age range, gender, subtypes of PPIs and methods of administration. A larger effect was observed in children with chronic kidney disease (OR, 3.37; 95% CI, 2.46-4.62) and those needed intensive care (OR, 1.54; 95% CI, 1.33-1.78). The risk of HA-AKI was increased even within the recommended dosage range of PPI.

Conclusions: PPIs were widely used and associated with an increased risk of HA-AKI in hospitalized children in China.

Keywords: Proton pump inhibitors (PPIs); hospital-acquired acute kidney injury (HA-AKI); nephrotoxicity; pediatrics.