Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan.
Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Kidney360. 2024 Sep 1;5(9):1262-1269. doi: 10.34067/KID.0000000000000528. Epub 2024 Aug 1.
This is the first study to use a large database of patients with cancer to examine the association between the studied drugs and AKI. The use of either proton pump inhibitors or immune checkpoint inhibitors was associated with an increased risk of AKI. However, their additive interaction was not identified.
An association between proton pump inhibitor (PPI) use and an increased risk of AKI has been confirmed. This study aimed to evaluate the effects of PPI use on the risk of AKI in patients with cancer who were administered immune checkpoint inhibitors (ICIs), a class of drugs used in cancer treatment, and in those who were not.
We used a database provided by the Health, Clinic, and Education Information Evaluation Institute, which included demographic data, diagnoses, prescriptions, and laboratory results. We conducted a nested case–control study of 38,930 patients with cancer who were new PPI or ICI users and had no history of AKI before cohort entry. The odds ratio (OR) for AKI was estimated using conditional logistic regression models.
During a mean follow-up of 8.3 months, 5870 cases of AKI were identified (incidence rate, 21.9/100 person-years). Compared with never or past PPI use without ICI use, the adjusted ORs of AKI for current PPI use without ICI use, past or never PPI use with prior ICI use, current PPI use with prior ICI use were 2.20 (95% confidence interval [CI], 2.01 to 2.40), 1.72 (95% CI, 1.37 to 2.17), or 2.62 (95% CI, 1.75 to 3.93), respectively. The risk of AKI in patients treated with both PPIs and ICIs was not higher than the additional or multiplication of the risks in those who were treated with PPIs or ICIs alone.
This study reinforces the association between PPI and ICI use and the increased risk of AKI. Although the interaction between the two drug classes was not detected, these findings highlight the need for careful monitoring and evaluation of kidney function in patients treated with PPIs and ICIs.
这是第一项使用大型癌症患者数据库研究研究药物与 AKI 之间关联的研究。质子泵抑制剂或免疫检查点抑制剂的使用与 AKI 风险增加相关。然而，没有发现它们的附加相互作用。
质子泵抑制剂（PPI）的使用与 AKI 风险增加之间存在关联。本研究旨在评估在接受免疫检查点抑制剂（ICI）治疗的癌症患者和未接受此类药物治疗的患者中，PPI 的使用对 AKI 风险的影响。
我们使用了健康、诊所和教育信息评估研究所提供的数据库，其中包含人口统计学数据、诊断、处方和实验室结果。我们对 38930 名新使用 PPI 或 ICI 且在入组前无 AKI 病史的癌症患者进行了嵌套病例对照研究。使用条件逻辑回归模型估计 AKI 的比值比（OR）。
在平均 8.3 个月的随访期间，共确定了 5870 例 AKI 病例（发生率为 21.9/100 人年）。与从未或过去使用 PPI 而未使用 ICI 相比，当前使用 PPI 而未使用 ICI、过去或从未使用 PPI 但先前使用 ICI、当前使用 PPI 且先前使用 ICI 的 AKI 的调整后 OR 分别为 2.20（95%置信区间[CI]，2.01 至 2.40）、1.72（95%CI，1.37 至 2.17）或 2.62（95%CI，1.75 至 3.93）。同时使用 PPI 和 ICI 的患者发生 AKI 的风险并不高于单独使用 PPI 或 ICI 的患者的风险相加或相乘。
本研究进一步证实了 PPI 和 ICI 使用与 AKI 风险增加之间的关联。尽管未检测到两种药物类别之间的相互作用，但这些发现强调了在使用 PPI 和 ICI 治疗的患者中需要仔细监测和评估肾功能。
