Do Proton-Pump Inhibitors Cause CKD and Progression of CKD?: COMMENTARY

Paueksakon, Paisit; Fogo, Agnes B.

doi:10.34067/kid.0008302021

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…Following adjustment for potential confounders such as baseline conditions of comorbidities, concomitant medications, baseline kidney function (baseline eGFR), sex and age, PPI users demonstrated a significantly higher rate of transition from G3 to G4 or G5 stages compared to H2B users, suggesting that PPI usage is associated with increased risk of CKD progression. These findings align with previous research indicating an association between PPI use and an increased risk of CKD progression [ 8 , 14 , 18 ]. Furthermore, we construed transitions to lower eGFR stages (i.e., larger eGFR values) as improvements or fluctuations, notwithstanding prevailing beliefs regarding the irreversibility of kidney function decline [ 44 ].…”

Section: Discussionsupporting

confidence: 92%

“…The underlying mechanism of PPI usage with adverse effects on CKD remains the subject of an ongoing inquiry. Plausible explanations include the induction of acute interstitial nephritis (AIN) [ 17 , 18 ] and hypomagnesemia [ 19 ] by the usage of PPIs. Delayed treatment or incomplete recovery from AIN can lead to acute kidney disease, potentially increasing the risk of developing CKD.…”

Section: Introductionmentioning

confidence: 99%

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The Assessment of the Association of Proton Pump Inhibitor Usage with Chronic Kidney Disease Progression through a Process Mining Approach

Chen,

Abtahi,

et al. 2024

Biomedicines

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Previous studies have suggested an association between Proton Pump Inhibitors (PPIs) and the progression of chronic kidney disease (CKD). This study aims to assess the association between PPI use and CKD progression by analysing estimated glomerular filtration rate (eGFR) trajectories using a process mining approach. We conducted a retrospective cohort study from 1 January 2006 to 31 December 2011, utilising data from the Stockholm Creatinine Measurements (SCREAM). New users of PPIs and H2 blockers (H2Bs) with CKD (eGFR < 60) were identified using a new-user and active-comparator design. Process mining discovery is a technique that discovers patterns and sequences in events over time, making it suitable for studying longitudinal eGFR trajectories. We used this technique to construct eGFR trajectory models for both PPI and H2B users. Our analysis indicated that PPI users exhibited more complex and rapidly declining eGFR trajectories compared to H2B users, with a 75% increased risk (adjusted hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.49 to 2.06) of transitioning from moderate eGFR stage (G3) to more severe stages (G4 or G5). These findings suggest that PPI use is associated with an increased risk of CKD progression, demonstrating the utility of process mining for longitudinal analysis in epidemiology, leading to an improved understanding of disease progression.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

The Assessment of the Association of Proton Pump Inhibitor Usage with Chronic Kidney Disease Progression through a Process Mining Approach

Chen,

Abtahi,

et al. 2024

Biomedicines

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“…Moreover, though PPIs should be used with vigilance, there is currently no need for wide adoption of de-escalation strategies with regard to long-term PPI use merely out of safety concerns [ 29 ]. The use of PPI cannot be the sole reason for renal damage when used concomitantly with nephrotoxic drugs [ 30 ]. Similarly, Moayyedi et al also showed that chronic pantoprazole use had no significant between-group difference between pantoprazole and placebo for incident events of CKD (2.1% vs. 1.8%; p=0.15) [ 6 ].…”

Section: Reviewmentioning

confidence: 99%

Long-Term Use of Proton-Pump Inhibitors: Unravelling the Safety Puzzle

Bhatnagar,

Choudhari,

Pawar

et al. 2024

Cureus

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Globally, over 25% of the population suffers from acid-related disorders such as dyspepsia or gastroesophageal reflux disease (GERD), and around 7.6% of Indians report having GERD symptoms on a frequent enough basis to warrant a diagnosis. Over the past three decades, proton-pump inhibitors (PPIs) have been the mainstay of medical therapy for acid-peptic diseases like GERD, etc. Additionally, they are frequently prescribed for prophylactic purposes and in conjunction with non-steroidal anti-inflammatory drugs. PPIs are generally prescribed for four to eight weeks. However, it may be prescribed for patients with comorbidities and multiple medications for a longer period of time. While this remains true in terms of effectiveness, concerns have been raised about the safety of long-term PPI use and the serious adverse effects that may result. Some of the observational and population-based cohort studies have shown an association between long-term use of PPIs and an increased risk of pneumonia, major cardiovascular events, dementia, vitamin B12 deficiency, bone fractures, gastric cancer, and kidney injury, among others. This review analyzes the clinical data supporting the long-term use of PPIs and takes a deep dive into whether these several emerging long-term concerns apply to the currently available PPIs in India. We have summarized a vast array of studies, including randomized trials, cohort studies, and meta-analyses, that report low or high incidences of major health risks linked with PPIs and have assessed their appropriateness over a given period.

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“…The risk factors for CKD include age, smoking, alcohol consumption, diabetes mellitus, and hypertension. Therefore, it is imperative that we focus on preventive and curative approaches of CKD ( 2 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…Model 4: adjusted for age, gender, race/ethnicity, education level, income-to-poverty ratio, caffeine intake, energy intake, diabetes mellitus history, and hypertension history. The specific range for the tertile: dietary OBS: T1 [2-13]; T2[13][14][15][16][17][18][19][20]; T3[20][21][22][23][24][25][26][27][28][29][30][31]; Lifestyle OBS: T1 [0-3]; T2[3][4]; T3[4][5][6][7][8].…”

mentioning

confidence: 99%

Association between oxidative balance score in adults with and without chronic kidney disease: 2011–2028 NHANES

Cao,

Zhou,

Zhong

et al. 2024

Front. Nutr.

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IntroductionOxidative stress status is associated with CKD; however, few studies have investigated this association. The oxidative balance score (OBS) reflects systemic stress status and consists of 16 anti-and pro-oxidant dietary factors and four anti-and pro-oxidant lifestyle factors. Higher OBS implies exposure to more antioxidants. The purpose of this study was to explore the association between OBS and CKD.MethodsWe enrolled 8,134 study participants from the 2011–2018 National Health and Nutrition Examination Survey and obtained OBS by adding the 20 dietary and lifestyle factors. Based on OBS, the participants were divided into three groups. We performed logistic regression, subgroup analyzes, and restricted cubic spline regression to explore the association between OBS and CKD. In addition, we tested the adjusted model.ResultsOBS was negatively associated with CKD (OR: 0.54; 0.66, 0.82). After adjusting for all confounders, when dietary OBS was >20, the prevalence of CKD was reduced by 42% for each unit increase in OBS (p < 0.05). The negative associations of total OBS, dietary OBS, and lifestyle OBS with CKD were more significant in the female group. When the total OBS was ~20, the trend of decreasing prevalence in the female group was more significant.ConclusionOBS is negatively associated with chronic kidney disease.

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Do Proton-Pump Inhibitors Cause CKD and Progression of CKD?: COMMENTARY

Abstract: This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the PRO: 10.34067/KID.0007622021 and the CON: 10.34067/KID.0005852021

Cited by 4 publications

References 11 publications

The Assessment of the Association of Proton Pump Inhibitor Usage with Chronic Kidney Disease Progression through a Process Mining Approach

The Assessment of the Association of Proton Pump Inhibitor Usage with Chronic Kidney Disease Progression through a Process Mining Approach

Long-Term Use of Proton-Pump Inhibitors: Unravelling the Safety Puzzle

Association between oxidative balance score in adults with and without chronic kidney disease: 2011–2028 NHANES

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