Kidney Week

Abstract: FR-PO413

Prescription Patterns of Proton-Pump Inhibitors and Antiplatelet Therapy as Risk Factors for Gastrointestinal Bleeding in Patients on Hemodialysis

Session Information

• Hemodialysis Epidemiology and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Che, Michael, University of Ottawa, Faculty of Medicine, Division of Nephrology, Ottawa, Ontario, Canada

Michael Che, MD

• Ahmed, Sumaiya, University of Ottawa, Faculty of Medicine, Division of Nephrology, Ottawa, Ontario, Canada

Sumaiya Ahmed, MD

• Chan, Ryan James, University of Toronto, Department of Medicine, Division of Nephrology, Toronto, Ontario, Canada

Ryan James Chan, MD

• Akbari, Ayub, University of Ottawa, Faculty of Medicine, Division of Nephrology, Ottawa, Ontario, Canada

Ayub Akbari, MD, MS, MSc, FASN

• Zimmerman, Deborah Lynn, University of Ottawa, Faculty of Medicine, Division of Nephrology, Ottawa, Ontario, Canada

Deborah Lynn Zimmerman, MD

Background

There is an increased risk of gastrointestinal bleeding (GI) in patients with end stage kidney disease (ESKD) for reasons including uremic platelet dysfunction, co-morbid illness, and use of antiplatelet agents. Proton pump inhibitors (PPI) reduce GI bleeding and are recommended for high-risk patients such as those prescribed dual antiplatelet therapy (DAPT). Whether inappropriate prescription of DAPT and/or lack of appropriate use of PPIs contribute to gastrointestinal bleeding risk in hemodialysis patients is not currently known. Thus, the objective of our project was to determine whether patients with ESKD are appropriately prescribed DAPT and PPI therapy.

Methods

A chart review was performed at a satellite hemodialysis unit of The Ottawa Hospital in Ontario, Canada in July 2023. Patients’ medical history and use of antiplatelets, PPIs, anticoagulants, non-steroidal anti-inflammatories (NSAIDs), and corticosteroids were identified. Patients’ indications for PPI and DAPT were elucidated. Subsequently, a note was added to the electronic medical record and communicated to the patients’ primary nephrologist stating if a patient was taking DAPT/PPI and whether these medications were indicated. Adjustments to medications could be made thereafter if needed.

Results

Of 88 hemodialysis patients, 44 were on antiplatelet therapy (4 on DAPT), 1 on NSAID, 12 on corticosteroids, 7 on anticoagulants, 2 on histamine H2-receptor antagonists, and 39 on PPIs. Fourteen percent of PPI users had absolute indication for therapy. One patient in whom PPI therapy was indicated was not prescribed one. Three of 4 DAPT users met current indications for therapy; 1 had a prior indication for DAPT and after review with their primary nephrology team, the patient was reduced to single antiplatelet therapy.

Conclusion

Only one patient in our study had an absolute indication for PPI but had not been prescribed one, and one patient prescribed DAPT no longer met criteria for continued use. Overall, prescribing patterns of DAPT and PPI are unlikely to be a major contributor to the increased risk of gastrointestinal bleeding in patients on hemodialysis at our center. Nevertheless, review of medications and medical history may improve outcomes in patients who have been inappropriately prescribed these therapies.