Renal dysfunction in routine proton-pump inhibitor use may be linked to comorbidities: A real-world observational study.

Abstract

The use of proton-pump inhibitors (PPI) is linked with infrequent but serious adverse events, including acute kidney injury, chronic kidney disease (CKD) and progression of CKD. Data on renal safety in routine use of PPI are more relevant to clinical practice. We studied whether such use of PPI is associated with renal dysfunction. Patients taking PPI for at least sixweeks had serum creatinine tested pre (n = 200) and post (n = 180) recruitment. These patients were then advised to follow-up: those taking PPI for at least 90days in the next sixmonths (n = 77) and at least another 90days in the following sixmonths (n = 50), had serum creatinine tested at such follow-up. Renal dysfunction was defined as any increase in serum creatinine level above baseline. The 200 patients recruited had mean age 39.6 (SD 9.2) years. Ninety-eight (49%) patients hada history of previous PPI use (median sixmonths; interquartile range [IQR] 3-24). Only 20 (11.1%) patients at sixweeks, 11 (14.3%) at six months and six (12%) at one year had increase in creatinine level; a majority of them had less than 0.3mg/dL increase. Ten of these 20 (sixweeks), five of 11 (six months) and five of six (one year) had other risk factors for renal dysfunction. No patient developed CKD during the study period. Mild and non-progressive increase in serum creatinine occurred in 10% to 15% of patients on routine PPI use. A majority of them had other risk factors. Small sample size and short follow-up duration are a few limitations of this study.