Comparative Effects of Proton Pump Inhibitors and Histamine-2 Receptor Blockers on Renal Function in Critically Ill Patients: A Retrospective Cohort Study

Öz

Aim: To compare the effects of proton pump inhibitors (PPIs) and histamine-2 receptor blockers (H₂RBs) on renal function in critically ill adults with preserved baseline kidney function. Methods: This retrospective cohort study included 210 intensive care unit (ICU) patients (105 PPIs, 105 H₂RBs) hospitalized for at least 15 days at Mersin City Training and Research Hospital. Serum creatinine and estimated glomerular filtration rate (eGFR) were recorded on ICU days 0, 5, 10, and 15. Acute kidney injury (AKI) was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Group comparisons were performed using appropriate parametric and non-parametric tests. A sensitivity analysis was conducted after excluding patients exposed to sepsis, vasopressors, contrast, or nephrotoxic drugs. Results: Baseline demographics, illness severity, and potential confounders were comparable between groups. The incidence of AKI was similar in the PPI and H₂RB groups (12.4% vs 13.3%, p = 0.81). Serial eGFR measurements followed parallel patterns, showing an early decline and partial recovery by day 15 (p > 0.05 for all time points). Results remained consistent after sensitivity analysis. Conclusion: Short-term PPI therapy did not increase AKI risk or impair renal function compared with H₂RB use. PPI administration limited to the acute ICU phase appears safe regarding renal outcomes; however, unnecessary or prolonged administration should be avoided in accordance with current stewardship recommendations.

Anahtar Kelimeler

• Proton Pump Inhibitors
• Histamine-2 Receptor Blockers
• Acute Kidney Injury
• Critically Ill Patients
• Intensive Care Unit
• Renal Function

Yoğun Bakım Hastalarında Proton Pompa İnhibitörleri ve Histamin-2 Reseptör Blokerlerinin Böbrek Fonksiyonları Üzerine Karşılaştırmalı Etkileri: Retrospektif Kohort Çalışması

Öz

Amaç: Bu çalışmanın amacı, yoğun bakım ünitesinde (YBÜ) yatan ve başlangıç böbrek fonksiyonu korunmuş erişkin hastalarda proton pompa inhibitörleri (PPİ) ile histamin-2 reseptör blokerlerinin (H₂RB) böbrek fonksiyonu üzerindeki etkilerini karşılaştırmaktır. Yöntem: Bu retrospektif kohort çalışmasına, Mersin Şehir Eğitim ve Araştırma Hastanesi yoğun bakım ünitesinde en az 15 gün süreyle yatan toplam 210 hasta (105 PPİ, 105 H₂RB) dahil edilmiştir. Serum kreatinin ve tahmini glomerüler filtrasyon hızı (eGFR) değerleri YBÜ’ye yatışın 0., 5., 10. ve 15. günlerinde kaydedilmiştir. Akut böbrek hasarı (ABH), Kidney Disease: Improving Global Outcomes (KDIGO) kriterlerine göre tanımlanmıştır. Gruplar arasındaki karşılaştırmalar uygun parametrik ve nonparametrik testlerle yapılmış; sepsis, vazopressör, kontrast madde veya nefrotoksik ilaç maruziyeti olan hastalar dışlanarak duyarlılık analizi gerçekleştirilmiştir. Bulgular: Gruplar arasında başlangıç demografik özellikleri, hastalık şiddeti ve olası karıştırıcı değişkenler açısından anlamlı fark bulunmamıştır. ABH insidansı PPİ ve H₂RB gruplarında benzerdi (sırasıyla %12,4 ve %13,3; p = 0,81). Seri eGFR ölçümleri her iki grupta da benzer seyir göstermiş, erken dönemde düşüş ve 15. günde kısmi toparlanma gözlenmiştir (tüm zaman noktalarında p > 0,05). Duyarlılık analizi sonrasında da sonuçlar değişmemiştir. Sonuç: Kısa süreli PPİ tedavisi, H₂RB kullanımına kıyasla akut böbrek hasarı riskini artırmamış ve böbrek fonksiyonlarını olumsuz etkilememiştir. YBÜ’nün akut döneminde sınırlı süreyle uygulanan PPİ tedavisi böbrek açısından güvenli görünmektedir; ancak gereksiz veya uzun süreli kullanımdan, mevcut akılcı ilaç kullanımı önerileri doğrultusunda kaçınılmalıdır.

Anahtar Kelimeler

• Proton Pompa İnhibitörleri
• Histamin-2 Reseptör Blokerleri
• Akut Böbrek Hasarı
• Yoğun Bakım Hastaları
• ; Yoğun Bakım Ünitesi
• Böbrek Fonksiyonu

Kaynakça

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