Demographic and health-related predictors of proton pump inhibitor (PPI) use and association with chronic kidney disease (CKD) stage in NHANES population.

Background: Reports of adverse outcomes with use of Proton Pump Inhibitors (PPIs) and recent associations between PPI use and Chronic Kidney Disease (CKD) suggest the need to examine PPI use in the general population.

Objectives: The purpose of this study was to examine PPI use in the general U.S. population with a focus on CKD stages.

Methods: This was a retrospective database study of the National Health and Nutrition Examination Survey (NHANES) for years 2009-2013. Inclusion criteria were age ≥ 18 years and having a serum creatinine value. The Andersen Behavioral Model of Health Services Utilization and previous research were used to identify the independent variables. Dependent variable was self-reported prescription medication use. Multinomial logistic regression models were used to examine factors associated with PPI use.

Results: Overall, the weighted prevalence of PPI use was 8.7%. Only 4.5% of the sample had stage 3 or 4 CKD. PPI use was highest among whites (10.5%) compared to minorities. PPI users were significantly older (mean = 59.8years), with a majority (80%) being 50 years and over. In multivariate analyses, PPI use was associated with having two or more comorbidities (OR = 3.8, CI: 2.85-5.13), and having fair/poor health (OR 4.6 (3.5-5.9). Stage 3 and 4 CKD patients had higher odds of using PPIs (stage 3 OR = 3.8 CI: 2.5-5.8, stage 4 OR = 6.5 CI: 1.6-25.8) compared to stage 1 patients.

Conclusion: /Relevance: This is the first study to examine both predictors and racial disparities in PPI use in the general US population. While PPI use was low, there were racial disparities in PPI use. Multiple comorbid conditions, lower quality of life, and stage 3/4 CKD were associated with PPI use. Awareness of these predictors will enable clinicians to target key patient groups for tailored education and closer monitoring of PPI use.