The Effect of Gastric Acid Suppressants and Prokinetics on Peritonitis in Peritoneal Dialysis Patients

Abstract

Introduction: Peritoneal dialysis (PD) related peritonitis is associated with high morbidity and mortality in end stage renal disease (ESRD) patients. A few studies suggested gastric acid suppressive therapy can increase peritonitis in PD patients and to our knowledge, there was no study to assess the effect of prokinetics on PD related peritonitis. This study was aimed to evaluate the association of gastric acid suppressive therapy or prokinetics treatment and PD related peritonitis in Korea.

Methods: This was a single center, retrospective, case-control design study. Medical records of 398 peritoneal dialysis patients were collected from January 2000 to September 2012 and were analyzed to compare patients with at least one episode of peritonitis (peritonitis group, group A) and patients who never had peritonitis (no peritonitis group, group B). All peritonitis episodes were analyzed to compare between peritonitis caused by enteric organism and peritonitis caused by non-enteric organism.

Results: Among 120 patients who met inclusion criteria, 61 patients had at least one episode of peritonitis and 59 patients never experienced peritonitis. Twenty-four of 61 patients (39.3%) in group A and 15 of 59 patients (25.4%) in group B used gastric acid suppressants. Only the use of H2-bloker (H2B) was a significant risk factor for PD related peritonitis. The use of proton pump inhibitor (PPI), the other antacids, and prokinetics was not associated with higher PD related peritonitis risk. A total of 81 episodes of peritonitis among 61 patients (group A) were divided into enteric peritonitis group and non-enteric peritonitis group. Acid suppressive therapy and prokinetics treatment were not associated higher enteric peritonitis risk in peritonitis group.

Conclusions: The use of H2B shows trend to increase the risk of overall PD related peritonitis. Further studies with larger samples are required to evaluate the potential risk of PD related peritonitis with the use of gastric acid suppressants or prokinetics.