Comparing safety of proton‐pump inhibitors versus H2‐receptor antagonists in kidney transplant recipients : A systematic review and meta‐analysis
Abstract What is known and objective Multiple studies have been conducted to compare the safety of proton‐pump inhibitors (PPIs) and H2‐receptor antagonists (H2RAs) as acid‐suppressive treatment in kidney transplant recipients with conflicting results. This systematic review and meta‐analysis aimed to evaluate the risk of adverse effects in kidney transplant patients receiving PPIs compared to those treated with H2RAs. Methods A systematic search was performed on the databases from inception to June 2021. The treatment effects were expressed as odds ratio (OR), weighted mean differences (WMD) and their 95% confidence intervals (CI) and pooled by a random‐effects model. Results and Discussions Eight studies, consisting 4,844 patients, were included. Patients were followed for a mean duration of 23.57 months after transplantation. Compared with H2RAs, PPIs exposure was associated with similar rate of biopsy‐proven acute rejection (BPAR) (OR = 1.05, 95% CI 0.83–1.34, p = 0.67), mortality (OR = 1.31, 95% CI 0.56–3.07, p = 0.533), graft loss (OR = 1.06, 95% CI 0.59–1.93, p = 0.842), Clostridioides difficile infection (OR = 1.37, 95% CI 0.49–3.85, p = 0.545) and pneumonia (OR = 1.83, 95% CI 0.95–3.52, p = 0.072). The estimated glomerular filtration rate (eGFR) at 12 months was lower in patients who received PPIs than those treated with H2RAs (WMD = −1.01, 95% CI −1.89 to −0.12 ml/min/1.73m2, p = 0.02). The PPI‐treated kidney transplant patients experienced higher rate of antibody‐mediated rejection (AMR) (OR = 1.87, 95% CI 1.03–3.04, p = 0.039) and hypomagnesemia (OR = 2.16, 95% CI 1.46–3.20, p ˂ 0.001). What is new and Conclusions Compared with H2RAs, PPIs were not associated with higher risks of BPAR, mortality, graft loss or infection‐related outcomes. However, taking PPIs was associated with higher rates of AMR and hypomagnesemia, and lower eGFR at one year after transplantation. Further well‐controlled studies are needed to assess the impact of acid‐suppressive strategy on long‐term outcomes in KTRs..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:47 |
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| Enthalten in: |
Journal of clinical pharmacy and therapeutics - 47(2022), 5, Seite 567-574 |
| Beteiligte Personen: |
Mohammadi, Keyhan [VerfasserIn] |
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| BKL: |
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| Anmerkungen: |
Copyright © 2022 John Wiley & Sons Ltd |
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| Umfang: |
8 |
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| doi: |
10.1111/jcpt.13589 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 520 | |a Abstract What is known and objective Multiple studies have been conducted to compare the safety of proton‐pump inhibitors (PPIs) and H2‐receptor antagonists (H2RAs) as acid‐suppressive treatment in kidney transplant recipients with conflicting results. This systematic review and meta‐analysis aimed to evaluate the risk of adverse effects in kidney transplant patients receiving PPIs compared to those treated with H2RAs. Methods A systematic search was performed on the databases from inception to June 2021. The treatment effects were expressed as odds ratio (OR), weighted mean differences (WMD) and their 95% confidence intervals (CI) and pooled by a random‐effects model. Results and Discussions Eight studies, consisting 4,844 patients, were included. Patients were followed for a mean duration of 23.57 months after transplantation. Compared with H2RAs, PPIs exposure was associated with similar rate of biopsy‐proven acute rejection (BPAR) (OR = 1.05, 95% CI 0.83–1.34, p = 0.67), mortality (OR = 1.31, 95% CI 0.56–3.07, p = 0.533), graft loss (OR = 1.06, 95% CI 0.59–1.93, p = 0.842), Clostridioides difficile infection (OR = 1.37, 95% CI 0.49–3.85, p = 0.545) and pneumonia (OR = 1.83, 95% CI 0.95–3.52, p = 0.072). The estimated glomerular filtration rate (eGFR) at 12 months was lower in patients who received PPIs than those treated with H2RAs (WMD = −1.01, 95% CI −1.89 to −0.12 ml/min/1.73m2, p = 0.02). The PPI‐treated kidney transplant patients experienced higher rate of antibody‐mediated rejection (AMR) (OR = 1.87, 95% CI 1.03–3.04, p = 0.039) and hypomagnesemia (OR = 2.16, 95% CI 1.46–3.20, p ˂ 0.001). What is new and Conclusions Compared with H2RAs, PPIs were not associated with higher risks of BPAR, mortality, graft loss or infection‐related outcomes. However, taking PPIs was associated with higher rates of AMR and hypomagnesemia, and lower eGFR at one year after transplantation. Further well‐controlled studies are needed to assess the impact of acid‐suppressive strategy on long‐term outcomes in KTRs. | ||
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