Does the Use of Gastric‐Acid Suppressants Increase the Risk of Peritonitis in Patients Undergoing Peritoneal Dialysis? A Meta‐Analysis

Gastric-acid suppressants (GASs) are commonly prescribed to patients undergoing peritoneal dialysis for various gastrointestinal disorders. However, long-term GAS use has been linked with the risk of enteric peritonitis in this patient population. To assess the association between the enteric peritonitis risk and GAS use in patients undergoing peritoneal dialysis for end-stage renal disease, we conducted a systematic search for relevant articles published until December 2023 in PubMed, Embase, and the Cochrane Library databases. We included 11 articles on the association between GAS use and enteric peritonitis risk in patients undergoing peritoneal dialysis. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) using fixed and random-effects models to obtain overall effect estimates. We also explored potential sources of heterogeneity through subgroup analyses. We qualitatively analyzed data from 11 studies (n = 1993 participants), out of which, nine studies were included in meta-analysis. The overall results revealed a significant association between the enteric peritonitis risk and the use of GASs (OR, 1.61; 95% CI, 1.26-2.05; p < 0.00001). The analysis of study design subgroups showed a significant association in retrospective cohort studies (OR, 1.70; 95% CI, 1.42-2.03; p < 0.00001) but not in case-control studies. Histamine-2 receptor antagonist (H2RA) use was significantly associated with enteric peritonitis (OR, 1.49; 95% CI, 1.05-2.11, p = 0.03), whereas proton pump inhibitor use was not (OR, 1.13; 95% CI, 0.72-1.77, p = 0.28). Our findings suggest a significant association between the development of enteric peritonitis and GAS use in patients undergoing peritoneal dialysis. However, the observed heterogeneity in study characteristics warrants caution in interpreting the results.