The Authors Reply

Abstract

Thank you for commenting on our work.1Kamal F. Khan M.A. Howden C.W. Proton pump inhibitors and chronic kidney disease.Kidney Int. 2017; 92: 515Abstract Full Text Full Text PDF Scopus (2) Google Scholar Exposure to proton pump inhibitors (PPIs) is associated with increased risk of chronic kidney disease with and without intervening acute kidney injury.2Xie Y. Bowe B. Li T. et al.Proton pump inhibitors and risk of incident CKD and progression to ESRD.J Am Soc Nephrol. 2016; 27: 3153-3163Crossref PubMed Scopus (213) Google Scholar, 3Xie Y. Bowe B. Li T. et al.Long-term kidney outcomes among users of proton pump inhibitors without intervening acute kidney injury.Kidney Int. 2017; 91: 1482-1494Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar In their letter to the editor, Kamal and colleagues reiterate some of the limitations highlighted in our Discussion. They also elaborate on the limitations of using prescription records to classify exposure to PPIs that are also available over the counter. We defined drug exposure according to prescription records, and it is possible that some cohort participants may have used over-the-counter PPIs; the potential misclassification of exposure (although unlikely as explained in our Discussion) would have resulted in underestimation of risk and biased the results toward the null hypothesis. The body of evidence suggests a significant association between PPI use and risk of kidney outcomes; both the precautionary principle and the Hippocratic principle of “primum non nocere” suggest that the burden of proof lies with the demonstration that PPIs are not harmful to the kidney. We vigorously encourage the development of randomized controlled trials to address this matter. Proton pump inhibitors and chronic kidney diseaseKidney InternationalVol. 92Issue 2PreviewIn their recent population cohort study using the Department of Veterans Affairs databases, Xie et al.1 evaluated a possible association between proton pump inhibitor (PPI) use and chronic kidney disease. They concluded that PPI use is an independent risk factor for the development of chronic kidney disease in the absence of prior acute kidney injury. However, limitations of the study design should be considered. The authors adjusted for hemoglobin A1C, cardiovascular disease, chronic lung disease, and use of angiotensin-converting enzyme inhibitors and nonsteroidal anti-inflammatory drugs. Full-Text PDF Open Archive