# Association of Proton Pump Inhibitor Use with Cancer in Patients Undergoing Maintenance Hemodialysis: A Population-Based Cohort Study

## TL;DR

Long-term use of proton pump inhibitors in hemodialysis patients is linked to a higher risk of certain cancers, but does not affect cancer survival rates.

## Contribution

This study is the first to show a link between long-term proton pump inhibitor use and increased cancer risk in hemodialysis patients.

## Key findings

- Long-term PPI use was associated with higher overall cancer risk, particularly pancreatic and renal cancers.
- PPI use did not significantly affect cancer-specific survival rates.
- The No-Prescription group had lower risks of thyroid, prostate, and liver cancers compared to PPI users.

## Abstract

Background: Despite widespread proton pump inhibitor (PPI) use in hemodialysis (HD), evidence on cancer risk in high-risk populations remains scarce. We investigated the association between PPI use and incident cancer in a population-based cohort of patients receiving HD. Methods: We used data from the 4th–7th HD quality assessments from South Korea and data linked to claims and death. We classified patients by PPI prescription over 1 year, including No-Prescription (no PPI during the year, n = 37,934); Short (PPI for <60 days, n = 9909); and Long (PPI for ≥60 days, n = 18,108) groups. Any cancer-free survival and overall survival by PPI use were evaluated. Results: The 5-year cancer-free rates for any cancer were 89.6%, 88.5%, and 88.1% in the No-Prescription, Short, and Long groups, respectively. The 5-year patient survival rate was 42.2%, 43.8%, and 40.3% in the No-Prescription, Short, and Long groups, respectively. Patients prescribed PPI had a higher cancer risk than those without a PPI prescription. However, survival among patients with cancer did not differ significantly across the three groups. The Long group had a higher risk of pancreatic and renal cancers than the other two groups. The No-Prescription group had lower risks of thyroid, prostate, and liver cancers than the other groups. Conclusions: In our study, long-term PPI use was associated with higher overall cancer risk, particularly pancreatic and renal cancers, compared with the No-Prescription group. Although PPI prescription did not significantly affect cancer-specific survival, the findings suggest that prolonged PPI use may contribute to cancer development in this population.