TY - JOUR
T1 - Proton pump inhibitors and risk of incident CKD and progression to ESRD
AU - Xie, Yan
AU - Bowe, Benjamin
AU - Li, Tingting
AU - Xian, Hong
AU - Balasubramanian, Sumitra
AU - Al-Aly, Ziyad
PY - 2016/1/1
Y1 - 2016/1/1
N2 - The association between proton pump inhibitors (PPI) use and risk of acute interstitial nephritis has been described. However, whether exposure to PPI associates with incident CKD, CKD progression, or ESRD is not known. We used Department of Veterans Affairs national databases to build a primary cohort of new users of PPI (n=173,321) and new users of histamine H2-receptor antagonists (H2 blockers; n=20,270) and followed these patients over 5 years to ascertain renal outcomes. In adjusted Cox survivalmodels, the PPI group, compared with the H2 blockers group, had an increased risk of incident eGFR,60 ml/min per 1.73 m2 and of incident CKD (hazard ratio [HR], 1.22; 95% confidence interval [95% CI], 1.18 to 1.26; and HR, 1.28; 95%CI, 1.23 to 1.34, respectively). Patients treated with PPI also had a significantly elevated risk of doubling of serumcreatinine level (HR, 1.53; 95%CI, 1.42 to 1.65), of eGFR decline.30%(HR, 1.32; 95% CI, 1.28 to 1.37), and of ESRD (HR, 1.96; 95% CI, 1.21 to 3.18). Furthermore, we detected a graded association between duration of PPI exposure and risk of renal outcomes among those exposed to PPI for 31-90, 91-180, 181-360, and 361-720 days compared with those exposed for #30 days. Examination of risk of renal outcomes in 1:1 propensity score-matched cohorts of patients taking H2 blockers versus patients taking PPI and patients taking PPI versus controls yielded consistent results. Our results suggest that PPI exposure associates with increased risk of incident CKD, CKD progression, and ESRD.
AB - The association between proton pump inhibitors (PPI) use and risk of acute interstitial nephritis has been described. However, whether exposure to PPI associates with incident CKD, CKD progression, or ESRD is not known. We used Department of Veterans Affairs national databases to build a primary cohort of new users of PPI (n=173,321) and new users of histamine H2-receptor antagonists (H2 blockers; n=20,270) and followed these patients over 5 years to ascertain renal outcomes. In adjusted Cox survivalmodels, the PPI group, compared with the H2 blockers group, had an increased risk of incident eGFR,60 ml/min per 1.73 m2 and of incident CKD (hazard ratio [HR], 1.22; 95% confidence interval [95% CI], 1.18 to 1.26; and HR, 1.28; 95%CI, 1.23 to 1.34, respectively). Patients treated with PPI also had a significantly elevated risk of doubling of serumcreatinine level (HR, 1.53; 95%CI, 1.42 to 1.65), of eGFR decline.30%(HR, 1.32; 95% CI, 1.28 to 1.37), and of ESRD (HR, 1.96; 95% CI, 1.21 to 3.18). Furthermore, we detected a graded association between duration of PPI exposure and risk of renal outcomes among those exposed to PPI for 31-90, 91-180, 181-360, and 361-720 days compared with those exposed for #30 days. Examination of risk of renal outcomes in 1:1 propensity score-matched cohorts of patients taking H2 blockers versus patients taking PPI and patients taking PPI versus controls yielded consistent results. Our results suggest that PPI exposure associates with increased risk of incident CKD, CKD progression, and ESRD.
UR - http://www.scopus.com/inward/record.url?scp=85011431641&partnerID=8YFLogxK
U2 - 10.1681/ASN.2015121377
DO - 10.1681/ASN.2015121377
M3 - Article
C2 - 27080976
AN - SCOPUS:85011431641
VL - 27
SP - 3153
EP - 3163
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
SN - 1046-6673
IS - 10
ER -