title: Proton pump inhibitor usage and the associated risk of pneumonia in patients with chronic kidney disease.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is a serious medical problem and public health issue in Taiwan. Gastrointestinal symptoms frequently occur in patients with CKD, and proton pump inhibitors (PPIs) have therapeutic indications for gastrointestinal disorders involving excessive acid production. However, PPIs may also increase the risk of developing pneumonia through acute and irreversible gastric acid suppression. This study aimed to characterize differences in the risk of pneumonia in patients with CKD who use PPIs.
  
  
  METHODS
  This population-based case-control cohort study in Taiwan collected data from the Taiwan Health Insurance Research Database. Cases studied consisted of all patients in the database with an initial diagnosis of CKD during the 5-year period from 1997 to 2002. Each patient with CKD who used PPIs during this 5-year period was tracked to identify the occurrence of any type of pneumonia. We estimated the adjusted hazard ratios (HRs) and 95% confidence interval (95% CI) by using multiple logistic regression analysis.
  
  
  RESULTS
  The adjusted HR of the risk of pneumonia for patients with CKD using PPIs was 2.21 (95% CI = 1.59-3.07, p < 0.001). The risk of pneumonia was found to be positively associated with administration of PPIs. We observed a greater risk of pneumonia in patients with CKD using PPIs than in patients not using PPIs.
  
  
  CONCLUSIONS
  Results of this study suggest that use of PPIs in CKD patients may be associated with increasing the risk of pneumonia. Physicians should exercise caution while prescribing PPIs for patients with CKD.
authors.affiliation: Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Intensive Care Unit, West-Garden Hospital, Taipei, Taiwan.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Laboratory Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hsiu-Chen
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Department of Neurology, General Cathay Hospital, Sijhih Branch, Taipei, Taiwan.
authors.forename: Hsiu-Li
authors.initials: HL
authors.lastname: Lin
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yi-Tsung
authors.initials: YT
authors.lastname: Lin
authors.affiliation: Department of Nephrology, West-Garden Hospital, Taipei, Taiwan.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Chou
authors.affiliation: Department of Nephrology, West-Garden Hospital, Taipei, Taiwan; Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Hsu
authors.affiliation: Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: cpfung@vghtpe.gov.tw.
authors.forename: Chang-Phone
authors.initials: CP
authors.lastname: Fung
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology*; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology
chemical_list: D054328:Proton Pump Inhibitors
keywords: Chronic kidney disease; Pneumonia; Proton pump inhibitors