Abstract
In recent years, the use of proton pump inhibitors (PPI), especially omeprazole, has been associated with development of chronic kidney disease (CKD). These drugs are widely used worldwide. Although some studies have found an association between the use of PPI and the onset of acute renal failure and CKD. This study aims to analyze the association between the continuous use of omeprazole and the progression of CKD in adult and elderly individuals. A retrospective cohort study was conducted with patients followed up at a nephrology clinic in Brazil, in 2016 and 2017. Information about clinical and sociodemographic data, health behaviors, and medication use were collected from all patients diagnosed with CKD through consultation of medical charts and the Brazilian health information system (SIS). The participants were allocated into two groups: users and non-users of omeprazole, and the progression of CKD was then evaluated for each group. In the bivariate analysis, the Mann-Whitney U test to compare the quantitative variables between groups, and the Pearson/Fisher two-tailed chi-square test to compare the categorical variables were applied. Multivariate analysis was performed using Cox regression. A total of 199 CKD patients were attended in the polyclinic, and of these, 42.7% were omeprazole users. There was a higher percentage of CKD progression in users (70.6%) compared to non-users (10.5%). The hazard ratio was 7.34 (CI: 3.94-13.71), indicating a higher risk of progression to worse stages of CKD in omeprazole users than in non-users. As for the other variables, no statistically significant difference was found between groups (p > 0.05). An association between omeprazole use and progression of CKD stage was identified, showing a higher risk of disease evolution among omeprazole users.
Highlights
Chronic kidney disease (CKD), characterized by progressive deterioration of biochemical and physiological functions of the body systems, can be defined as a syndrome caused by the progressive decrease in renal function [1,2,3,4].In Brazil about 10 million people present some level of renal dysfunction, and the worldwide incidence of renal disease increases around 10% per year [5]
A total of 199 CKD patients were attended in the polyclinic, and of these, 42.7% were omeprazole users
There was a higher percentage of CKD progression in users (70.6%) compared to non-users (10.5%)
Summary
Chronic kidney disease (CKD), characterized by progressive deterioration of biochemical and physiological functions of the body systems, can be defined as a syndrome caused by the progressive decrease in renal function [1,2,3,4].In Brazil about 10 million people present some level of renal dysfunction, and the worldwide incidence of renal disease increases around 10% per year [5]. Because of the changes in life expectancy that have made the elderly become the dominant group in populations worldwide, the epidemiological figures of CKD are increasing continually, placing renal diseases in the epidemic category. This is a troubling situation and needs to be quickly controlled to try to minimize the devastating impacts of CKD, for patients, and for public managers who have to invest large amounts of money in the attempt to provide quality treatment for those affected [6]. Proton pump inhibitors (PPI), highly prescribed worldwide to treat gastroesophageal reflux and peptic ulcers through inhibition of gastric acid synthesis, have shown to be closely associated with acute interstitial nephritis (AIN), reduction of glomerular filtration rate (GFR) and the development of CKD [7,8,9,10,11]
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