Key result
Low-dose PPI is not linked to lower UGIB in aspirin-treated CKD patients, except those on dialysis.
Why the study?
Does low-dose PPI reduce non-variceal upper gastrointestinal bleeding in chronic kidney disease patients receiving aspirin?
Cohort (n=500)
Does low-dose PPI reduce non-variceal upper gastrointestinal bleeding in chronic kidney disease patients receiving aspirin?
Absolute Event Rate: 8.9% vs 25.9%
p-value: p=0.113
Prophylactic low-dose PPI may reduce the risk of non-variceal upper gastrointestinal bleeding specifically in dialysis patients receiving aspirin, though not in the overall CKD population.
Does not support routine PPI prophylaxis in aspirin-treated CKD patients; leaves open possible dialysis-subgroup benefit for prospective trials.
BACKGROUND AND AIM: Upper gastrointestinal bleeding (UGIB) leads to significant morbidity and mortality in chronic kidney disease (CKD) patients. This study determined the efficacy of using a low-dose proton pump inhibitor (PPI) to reduce the risk of non-variceal UGIB in CKD patients receiving aspirin. METHODS: We retrospectively reviewed the medical records of 500 CKD patients who received aspirin between January 2008 and March 2013. Cumulative incidence analysis using the Kaplan-Meier method was performed to analyze the rate of non-variceal UGIB and association with the administration of low-dose PPI. RESULTS: Of the 500 patients, 191 received low-dose PPI. Over the follow-up period, which lasted 1067 person-years, three patients in the low-dose PPI group (8.9 per 1000 person-years) and 19 patients in the non-PPI group (25.9 per 1000 person-years) developed non-variceal UGIB, respectively (P = 0.113). Low-dose PPI use did not decrease the risk of UGIB in CKD patients, including patients who did not receive dialysis (P = 0.127). However, according to the subgroup analysis of 230 patients who received dialysis, the low-dose PPI group (14.4 per 1000 person-years) demonstrated significantly reduced incidence and risk of non-variceal UGIB in comparison with the non-PPI group (53.8 per 1000 person-years) (P = 0.032). CONCLUSION: Prophylactic low-dose PPI can reduce the risk of non-variceal UGIB in dialysis patients receiving aspirin.
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Lim et al. (2014) conducted a cohort in Chronic kidney disease (CKD) (n=500). Low-dose proton pump inhibitor (PPI) vs. Non-PPI was evaluated on Non-variceal upper gastrointestinal bleeding (UGIB) (p=0.113). Low-dose PPI use did not significantly reduce non-variceal UGIB in CKD patients receiving aspirin (8.9 vs 25.9 per 1000 person-years; P=0.113), though it was effective in the dialysis subgroup.
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