[Poster's comment:- " It is suggested that anyone worried by these findings should print off this article and utilize it to highlight their concerns in discussion with their Practitioner"]
Long term PPI use may affect kidney function
British Medical Journal
15 Apr 16
Long term use of proton pump inhibitors (PPIs) for heartburn, acid reflux, or gastric ulcers is associated with a higher risk of new onset chronic kidney disease, progression of existing chronic kidney disease, and end stage renal disease, a large US study has shown.1
Reports have previously linked taking a PPI to acute kidney injury and acute interstitial nephritis. But it has been unclear whether exposure to these drugs is associated with the development or progression of chronic kidney disease.
Researchers studied the US Department of Veterans Affairs national databases to build a cohort of new users of PPIs (n=20 270) and new users of histamine H2 receptor antagonists (H2 blockers; n=173 321) prescribed for similar gastrointestinal conditions. They then followed them up for five years, looking at measures of renal function.
Results showed that people taking PPIs had an increased risk of developing impaired renal function and of incident chronic kidney disease than those taking H2 blockers.
The risk of developing an estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.73 m2 (the level at which chronic kidney disease is diagnosed) was 22% higher in people taking PPIs than in those taking H2 blockers (hazard ratio 1.22 (95% confidence interval 1.18 to 1.26)), after adjusting for demographic factors, eGFR, and comorbidities.
Taking a PPI was associated with a 28% higher risk of incident chronic kidney disease (adjusted hazard ratio 1.28 (1.23 to 1.34)) and a near doubling in the rate of end stage renal disease (1.96 (1.21 to 3.18)).
The risk of adverse renal outcomes increased with the duration of PPI exposure. When compared with people taking PPIs for 30 days or less, those taking them for 31-90 days had nearly twice the risk of a reduced eGFR of less than 60 mL/min per 1.73m2 (hazard ratio 1.94). This risk was higher still among people taking a PPI for 91-180 days (2.30) and in people taking them for one to two years (2.75).
“We show that exposure to PPI is associated with increased risk of development of CKD [chronic kidney disease], progression of kidney disease and risk of end stage renal disease,” said the researchers. “Results also suggest a graded relationship between duration of exposure and risk of renal outcomes.”
The researchers said that the link between PPIs and decreased renal function may be due to hypomagnesaemia but noted that this needs further research.
They warned, “PPIs are widely used and generally perceived as safe. They are often over-prescribed, started inappropriately during a hospital stay and their use extended for long term duration without appropriate medical indication.”
1. Xie Y, Bowe B, Li T, et al. Proton pump inhibitors and risk of incident chronic kidney disease and progression to ESRD. J Am Soc Nephrol 2016. doi:10.1681/ASN.2015121377.
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