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The following is a summary of “Accelerated risk of renal disease progression in pre-ESRD patients with proton pump inhibitors use: a nationwide population-based study,” published in the December 2024 issue of Nephrology by Huang et al. 

Proton pump inhibitors (PPIs) are commonly prescribed for gastrointestinal (GI) diseases, with several studies linking PPIs to adverse renal outcomes. Most research focuses on their effects on patients with normal renal function or early-stage chronic kidney disease (CKD). 

Researchers conducted a retrospective study on PPIs in patients with pre-ESRD, finding increased acute kidney injury (AKI) risk and accelerated renal progression in advanced CKD. 

They conducted a retrospective cohort study including adult patients with CKD (stages 3b to 5) who initiated PPI or H2 blocker therapy between 2011 and 2018. The risk of renal events was assessed using the Cox proportional hazard model to estimate the adjusted hazard ratio (HR) and 95% CI. Sensitivity analyses included propensity score matching, as-treated analysis, and subgroup analysis. 

The results showed that the cohort included 83,432 patients with pre-ESRD, with 5,138 treated with H2B and 1,051 with PPIs. PPI use was associated with a higher risk of ESRD progression (adjusted HR, 1.495; 95% CI: 1.198–1.867). Omeprazole (adjusted HR, 1.784; 95% CI: 1.079–2.951) and esomeprazole (adjusted HR, 1.847; 95% CI: 1.332–2.561) showed notably higher risks of ESRD and AKI. 

Investigators highlighted the accelerated renal risk in moderate to advanced patients with CKD using PPIs, stressing the need for careful prescribing in patients with pre-ESRD. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03867-6