Proton Pump Inhibitor As An Independent Factor Of Progression Of Abdominal Aortic Calcification In Patients On Maintenance Hemodialysis

BackgroundsProton 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.Materials and methodsWe 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 Delta ACI. Patients were divided into PPI and non-PPI groups, and variables, such as patient background, medication, laboratory data, and Delta ACI were compared. Factors independently associated with higher Delta ACI progression (>= third tertile value of Delta ACI in this study) were determined using multivariate logistic regression analysis.ResultsThe PPI and non-PPI groups had 112 (56%) and 88 (44%) patients, respectively. Median and third tertile value of Delta ACIs 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 Delta ACI 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 Delta ACI. 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 Delta ACI progression after adjusting for confounders.ConclusionPPI use may accelerate vascular calcification in patients on HD. Further studies are necessary to elucidate their influence on vascular calcification.