Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, Aomori, Japan.
Department of Urology, Hirosaki University Graduate School of Medicine, Aomori, Japan.
PLoS One. 2018 Jul 3;13(7):e0199160. doi: 10.1371/journal.pone.0199160. eCollection 2018.
Proton pump inhibitors (PPIs) can be associated with vascular calcification in patients undergoing dialysis through hypomagnesemia. However, only few studies have demonstrated the influence of PPIs on vascular calcification in patients on maintenance hemodialysis (HD). This study aimed to investigate whether the use of PPIs accelerates vascular calcification in patients on HD.
We retrospectively evaluated 200 HD patients who underwent regular blood tests and computed tomography (CT) between 2016 and 2017. The abdominal aortic calcification index (ACI) was measured using abdominal CT. The difference in the ACI values between 2016 and 2017 was evaluated as ΔACI. Patients were divided into PPI and non-PPI groups, and variables, such as patient background, medication, laboratory data, and ΔACI were compared. Factors independently associated with higher ΔACI progression (≥ third tertile value of ΔACI in this study) were determined using multivariate logistic regression analysis.
The PPI and non-PPI groups had 112 (56%) and 88 (44%) patients, respectively. Median and third tertile value of ΔACIs were 4.2% and 5.8%, respectively. Serum magnesium was significantly lower in the PPI (2.1 mg/dL) than in the non-PPI (2.3 mg/dL) group (P <0.001). Median ΔACI was significantly higher in the PPI (5.0%) than in the non-PPI (3.8%) group (P = 0.009). A total of 77 (39%) patients had a higher ΔACI. Multivariate analysis revealed that PPIs (odds ratio = 2.23; 95% confidence interval = 1.11-4.49), annual mean calcium phosphorus product, ACI in 2016, baseline serum magnesium levels, and HD vintage were independent factors associated with higher ΔACI progression after adjusting for confounders.
PPI use may accelerate vascular calcification in patients on HD. Further studies are necessary to elucidate their influence on vascular calcification.
质子泵抑制剂（PPIs）可通过低镁血症导致透析患者发生血管钙化。然而，仅有少数研究表明 PPI 会影响维持性血液透析（HD）患者的血管钙化。本研究旨在探讨 PPI 是否会加速 HD 患者的血管钙化。
我们回顾性评估了 2016 年至 2017 年期间接受常规血液检查和计算机断层扫描（CT）的 200 名 HD 患者。使用腹部 CT 测量腹主动脉钙化指数（ACI）。评估 2016 年至 2017 年 ACI 值的差值作为 ΔACI。将患者分为 PPI 组和非 PPI 组，比较患者背景、药物、实验室数据和 ΔACI 等变量。使用多变量 logistic 回归分析确定与更高 ΔACI 进展（本研究中更高 ΔACI 的第三 tertile 值）相关的独立因素。
PPI 组和非 PPI 组分别有 112 名（56%）和 88 名（44%）患者。ΔACI 的中位数和第三 tertile 值分别为 4.2%和 5.8%。PPI 组的血清镁（2.1 mg/dL）显著低于非 PPI 组（2.3 mg/dL）（P <0.001）。PPI 组的中位 ΔACI（5.0%）显著高于非 PPI 组（3.8%）（P = 0.009）。共有 77 名（39%）患者的 ΔACI 更高。多变量分析显示，PPI（比值比 = 2.23；95%置信区间 = 1.11-4.49）、年度平均钙磷乘积、2016 年 ACI、基线血清镁水平和 HD 使用年限是在调整混杂因素后与更高 ΔACI 进展相关的独立因素。
PPI 的使用可能会加速 HD 患者的血管钙化。需要进一步研究来阐明其对血管钙化的影响。
