{"title":"质子泵抑制剂、免疫检查点抑制剂与急性肾损伤之间的关系:一项嵌套病例对照研究。","authors":"Chinami Yamawaki, Shunsaku Nakagawa, Keiko Ikuta, Yurie Katsube, Natsuki Imayoshi, Yuki Shigetsura, Daiki Hira, Shinya Yamamoto, Takeshi Matsubara, Motoko Yanagita, Tomohiro Terada","doi":"10.34067/KID.0000000000000528","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>An association between proton pump inhibitor (PPI) use and an increased risk of acute kidney injury (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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>During a mean follow-up of 8.3 months, 5,870 cases of AKI were identified (incidence rate, 21.9/100 person-years). Compared to 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 1.82 (95% CI, 1.67 to 2.00), 1.47 (95% CI, 1.17 to 1.86), or 2.13 (95% CI, 1.42 to 3.20), 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.</p><p><strong>Conclusions: </strong>This study reinforces the association between PPIs and ICIs 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.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association between Proton Pump Inhibitors, Immune Checkpoint Inhibitors, and Acute Kidney Injury: A Nested Case-Control Study.\",\"authors\":\"Chinami Yamawaki, Shunsaku Nakagawa, Keiko Ikuta, Yurie Katsube, Natsuki Imayoshi, Yuki Shigetsura, Daiki Hira, Shinya Yamamoto, Takeshi Matsubara, Motoko Yanagita, Tomohiro Terada\",\"doi\":\"10.34067/KID.0000000000000528\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>An association between proton pump inhibitor (PPI) use and an increased risk of acute kidney injury (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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>During a mean follow-up of 8.3 months, 5,870 cases of AKI were identified (incidence rate, 21.9/100 person-years). Compared to 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 1.82 (95% CI, 1.67 to 2.00), 1.47 (95% CI, 1.17 to 1.86), or 2.13 (95% CI, 1.42 to 3.20), 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.</p><p><strong>Conclusions: </strong>This study reinforces the association between PPIs and ICIs 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.</p>\",\"PeriodicalId\":17882,\"journal\":{\"name\":\"Kidney360\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Kidney360\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.34067/KID.0000000000000528\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kidney360","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.34067/KID.0000000000000528","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:质子泵抑制剂(PPI)的使用与急性肾损伤(AKI)风险增加之间的关联已得到证实。本研究旨在评估服用免疫检查点抑制剂(ICIs)(一类用于癌症治疗的药物)的癌症患者和未服用ICIs的癌症患者服用质子泵抑制剂对急性肾损伤风险的影响:我们使用了由健康、诊所和教育信息评估研究所(Health, Clinic, and Education Information Evaluation Institute)提供的数据库,其中包括人口统计学数据、诊断、处方和实验室结果。我们对 38,930 名癌症患者进行了巢式病例对照研究,这些患者都是 PPI 或 ICI 的新使用者,且在加入队列前没有 AKI 病史。采用条件逻辑回归模型估算了发生 AKI 的几率比(OR):在平均 8.3 个月的随访期间,共发现 5,870 例 AKI(发病率为 21.9/100 人年)。与从未或既往使用 PPI 但未使用 ICI 相比,当前使用 PPI 但未使用 ICI、既往或从未使用 PPI 但既往使用 ICI、当前使用 PPI 但既往使用 ICI 的 AKI 调整 OR 分别为 1.82(95% CI,1.67 至 2.00)、1.47(95% CI,1.17 至 1.86)或 2.13(95% CI,1.42 至 3.20)。同时接受 PPIs 和 ICIs 治疗的患者发生 AKI 的风险并不比仅接受 PPIs 或 ICIs 治疗的患者的额外风险或倍增风险高:这项研究加强了 PPIs 和 ICIs 的使用与 AKI 风险增加之间的关联。尽管未发现这两类药物之间存在相互作用,但这些发现强调了对使用 PPIs 和 ICIs 治疗的患者进行肾功能仔细监测和评估的必要性。
Association between Proton Pump Inhibitors, Immune Checkpoint Inhibitors, and Acute Kidney Injury: A Nested Case-Control Study.
Background: An association between proton pump inhibitor (PPI) use and an increased risk of acute kidney injury (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.
Methods: 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.
Results: During a mean follow-up of 8.3 months, 5,870 cases of AKI were identified (incidence rate, 21.9/100 person-years). Compared to 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 1.82 (95% CI, 1.67 to 2.00), 1.47 (95% CI, 1.17 to 1.86), or 2.13 (95% CI, 1.42 to 3.20), 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.
Conclusions: This study reinforces the association between PPIs and ICIs 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.