A CME Journal for GPs and MD Physicians

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Many PPI Users Experience Silent Kidney Damage

Many patients taking proton pump inhibitors (PPIs) do not experience acute kidney injury before developing chronic kidney disease (CKD) or end-stage renal disease (ESRD), according to the results of a recent study.
Past research has linked the use of PPIs with a risk of kidney disease. Often, the sudden onset of acute kidney injury serves as an indicator to discontinue PPI use to avoid progression to CKD.

However, whether the use of PPIs is still associated with kidney damage in the absence of this red flag is unknown.To explore this issue, researchers conducted a study of 144,032 incident users of acid suppression therapy, including 125,596 PPI users and 18,436 histamine H2 receptor antagonist (H2 blockers) users. Over 5 years of follow-up, users of PPIs had an increased risk of having an estimated glomerular filtration rate (eGFR) under 60 ml/min/1.73m2, incident CKD, eGFR decline over 30%, and ESRD or eGFR decline over 50%, compared to those taking H2 blockers.

The results remained consistent in models excluding participants with acute kidney injury either before chronic renal outcomes, during the study, or before cohort entry.
“The proportion of PPI effect mediated by [acute kidney injury] was 44.7%, 45.47%, 46.00%, and 46.72% for incident eGFR under 60 ml/min/1.73m2, incident CKD, eGFR decline over 30%, and ESRD or over 50% decline in eGFR, respectively,” the researchers wrote.

“Thus, PPI use is associated with increased risk of chronic renal outcomes in the absence of intervening [acute kidney injury]. Hence, reliance on antecedent [acute kidney injury] as warning sign to guard against the risk of CKD among PPI users is not sufficient as a sole mitigation strategy,” they concluded.


REFERENCE:
Xie Y, Bowe B, Li T, et al. Long-term kidney outcomes among users
of proton pump inhibitors without intervening acute kidney injury
[published online February 22, 2017]. Kidney Int. DOI: http://dx.
doi.org/10.1016/j.kint.2016.12.021.

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