Abstract
BackgroundThe relationship between proton-pump inhibitor (PPI) use and chronic kidney disease (CKD) progression remains controversial. Specifically, there is a lack of data evaluating renal outcomes in established CKD patients. The aim of our study is to determine the risk of progression to end-stage kidney disease (ESKD) or death amongst CKD patients on PPI, histamine-2 receptor blocker (H2B), or no anti-acid therapy.MethodsUsing our CKD registry, we evaluated the relationship between PPI and H2B use and outcomes amongst patients with CKD (eGFR < 60), with at least 2 PCP visits in the year prior. A Cox proportional hazards model was used to evaluate the relationship between medication groups and overall mortality, while competing risks regression models were used to determine the risk of ESKD with death as a competing risk.Results25,455 patients met inclusion criteria and were stratified according to medication group: no antacid therapy (15,961), PPI use (8646), or H2B use (848). At 4 years, the cumulative incidence of ESKD with death as a competing risk was 2.0% (95% CI: 1.7, 2.4), 1.5% (0.8, 2.8), and 1.6%(1.4, 1.9) among PPI, H2B, and no medication respectively (P = 0.22). The cumulative incidence of death with ESKD as a competing risk was 17.6% (95% CI: 16.6, 18.6), 16.7% (13.7, 19.8), and 17.3% (16.6, 18.0) (P = 0.71).ConclusionsUse of PPI in a CKD population was not associated with increased mortality or progression to ESKD when compared to H2 blocker and to no acid suppressing therapy.
Highlights
Since the introduction of Omeprazole in 1989, Proton Pump Inhibitors (PPIs) have gone on to become one of the most widely prescribed medications in the United States
Patient population We used data from our Electronic Health Record (EHR) - based Chronic Kidney Disease (CKD) registry to evaluate the relationship between the use of proton-pump inhibitors (PPI) and H2 blockers and outcomes
We evaluated whether patients had continuity of care at our institution by searching for 2 completed visits or appointments with the listed primary care provider (PCP) within the year prior to the second eGFR < 60 ml/ min/1.73 m2
Summary
Since the introduction of Omeprazole in 1989, Proton Pump Inhibitors (PPIs) have gone on to become one of the most widely prescribed medications in the United States These drugs are increasingly sold over the counter (OTC), making the actual use of PPIs across the general population much higher. Some studies have suggested an increased risk of developing chronic kidney disease (CKD) among patients with normal renal function [10,11,12,13,14]. To the best of our knowledge, only one such study has been published [16] It concluded that PPI use was associated with increased major renal adverse events, defined as doubling of serum creatinine or progression to end-stage renal disease. The relationship between proton-pump inhibitor (PPI) use and chronic kidney disease (CKD) progression remains controversial. The aim of our study is to determine the risk of progression to end-stage kidney disease (ESKD) or death amongst CKD patients on PPI, histamine-2 receptor blocker (H2B), or no anti-acid therapy
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