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PPI use heightens risk for chronic kidney disease

People who use proton pump inhibitors, or PPIs, had a 1.4-fold increased risk for chronic kidney disease, according to an analysis of Taiwan national health insurance data.

“The adverse effects of using PPIs over longer time periods are now becoming evident. Since almost all PPIs are metabolized by the liver, the potential burden of these drugs upon the renal system was not initially evident or considered,” Shih-Chang Hung, MD, DrPH, from the department of emergency medicine at Nantou Hospital in Taiwan, and colleagues wrote in Family Practice. “[Previous research raised] suspicions of an association between PPIs and acute kidney injury; however, these associations were not confirmed.”

Researchers conducted a population-based, case-controlled study to determine the association between PPI use and the risk for chronic kidney disease (CKD) in Taiwan using data from the Taiwan National Health Insurance program. They included 16,704 cases of patients aged 20 years or older who were diagnosed with CKD between 2000 and 2013, then used a logistic regression model to estimate the odds of CKD linked to PPIs use.

Use of PPIs presented a 1.41-fold higher risk of CKD compared with nonuse of PPIs (95% CI 1.34-1.48). Cumulative duration and dosage regression analysis showed that almost all major types of PPIs were weakly associated with increased chance for CKD, including esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole. The risk for CKD was higher after a month of PPI use compared with patients who did not use PPIs (OR = 1.02; 95% CI 1.01-1.02), and the odds ratio of having CKD was 1.23 (95% CI 1.18, 1.28) in patients using PPIs with increasing dosage per microgram when compared with those who did not use PPIs. Hung and colleagues also found that the longer the patient used PPIs, the higher the risk for CKD. Patients with CKD were more likely to have a higher proportion of NSAID use than controls as well (96.3% vs. 95.7%; P = .01).

“We clearly demonstrated that PPI use was associated with an increasing risk of CKD with a dose response effect,” Hung and colleagues wrote. “Further long-term prospective study also collecting the detailed physical and laboratory examination data to demonstrate the CKD evolving due to PPI exposure is needed to confirm the association.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.