The purpose of this project was to identify how many kidney transplant patients were taking a proton pump inhibitor (PPI) after kidney transplant at our institute without an indication and also to compare renal function, rates of clostridium difficile (C diff), and rates of hypomagnesemia in patients taking a PPI after kidney transplant compared to those not taking a PPI.

This QI project retrospectively evaluated kidney transplant patients who received a kidney transplant between 1996 and 2017 at our institution. An Electronic Medical Record search was conducted to identify all kidney transplant patients taking a PPI as of July 17, 2017. Patients were excluded for incomplete medication histories on file and incarceration. The primary endpoint was the proportion of kidney transplant patients that were utilizing a PPI without an indication. Secondary endpoints were to compare current renal function, the incidence of C diff, and the incidence of hypomagnesemia in patients taking a PPI after transplant compared to those were not taking a PPI.

A total of 885 patients were identified during the study period of which 66 patients were excluded. A total of 404 patients were taking a PPI while 415 patients were not currently taking a PPI. Of the 404 patients on PPI therapy, 156 patients (37%) had no documented indication for a PPI. Patients on PPI therapy had a mean SCr of 1.896 (±1.53) compared to SCr of 1.812 (±1.25) in those not taking a PPI (p=0.4098). A total of 24 patients (6.2%) on PPIs were receiving HD compared to 31 patients (8.2%) who were not on a PPI receiving HD (p=0.284). C diff infection was found in 26 (3.1%) patients. Of those 26 patients, 18 (4.5%) of them were utilizing a PPI at the time of infection compared to 8 (1.9%) who were not currently utilizing a PPI (P = 0.039). Hypomagnesemia occurred in 215 patients (53.1 %) taking PPIs compared to 185 patients (44.6 %) not taking PPIs (p < 0.013).

This study identified that the majority of patients at our institution were receiving a PPI after kidney transplant with no true indication. Furthermore, the use of PPIs was associated with increased rates of C diff and hypomagnesemia in a population that already is at risk for these adverse events. Renal function did not differ between groups.

CITATION INFORMATION: Kipp G., Dancsecs K., Lapping A. Proton-Pump Inhibitor Utilization is Associated with Higher Rates of Clostridium difficile Infection and Hypomagnesemia after Kidney Transplant Am J Transplant. 2017;17 (suppl 3).

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