Proton pump inhibitor use and progression to major adverse renal events: a competing risk analysis

Grant, Christopher H.; Gillis, Keith; Lees, Jennifer S; Traynor, Jamie P.; Mark, Patrick B.; Stevens, Kate

doi:10.1093/qjmed/hcz166

Cited by 18 publications

(22 citation statements)

References 31 publications

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“…Proponents of population based epidemiology argue that the 3 year randomized controlled trial was still too small and too short to detect rare long term adverse events associated with PPI use. Instead they point to the many population based studies and meta-analyses of PPI risks summarized in table 3 8081828384858687888990919293949596979899100101. However, the mechanistic hypotheses that link these adverse outcomes to PPI use are without support from experimental studies.…”

Section: Managementmentioning

confidence: 99%

Advances in the diagnosis and management of gastroesophageal reflux disease

Katzka

Kahrilas

2020

BMJ

100

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Gastroesophageal reflux disease (GERD) is a multifaceted disorder encompassing a family of syndromes attributable to, or exacerbated by, gastroesophageal reflux that impart morbidity, mainly through troublesome symptoms. Major GERD phenotypes are non-erosive reflux disease, GERD hypersensitivity, low or high grade esophagitis, Barrett’s esophagus, reflux chest pain, laryngopharyngeal reflux, and regurgitation dominant reflux. GERD is common throughout the world, and its epidemiology is linked to the Western lifestyle, obesity, and the demise of Helicobacter pylori. Because of its prevalence and chronicity, GERD is a substantial economic burden measured in physician visits, diagnostics, cancer surveillance protocols, and therapeutics. An individual with typical symptoms has a fivefold risk of developing esophageal adenocarcinoma, but mortality from GERD is otherwise rare. The principles of management are to provide symptomatic relief and to minimize potential health risks through some combination of lifestyle modifications, diagnostic testing, pharmaceuticals (mainly to suppress or counteract gastric acid secretion), and surgery. However, it is usually a chronic recurring condition and management needs to be personalized to each case. While escalating proton pump inhibitor therapy may be pertinent to healing high grade esophagitis, its applicability to other GERD phenotypes wherein the modulating effects of anxiety, motility, hypersensitivity, and non-esophageal factors may dominate is highly questionable.

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Section: Managementmentioning

confidence: 99%

Advances in the diagnosis and management of gastroesophageal reflux disease

Katzka

Kahrilas

2020

BMJ

100

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“…Despite the growing body of evidence on PPI use and increased risk for developing CKD, there is limited data on patients with already established CKD. To the best of our knowledge, only one such study has been published [16]. It concluded that PPI use was associated with increased major renal adverse events, defined as doubling of serum creatinine or progression to end-stage renal disease.…”

Section: Introductionmentioning

confidence: 99%

Proton-pump inhibitor vs. H2-receptor blocker use and overall risk of CKD progression

et al. 2021

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Background The relationship between proton-pump inhibitor (PPI) use and chronic kidney disease (CKD) progression remains controversial. Specifically, there is a lack of data evaluating renal outcomes in established CKD patients. The aim of our study is to determine the risk of progression to end-stage kidney disease (ESKD) or death amongst CKD patients on PPI, histamine-2 receptor blocker (H2B), or no anti-acid therapy. Methods Using our CKD registry, we evaluated the relationship between PPI and H2B use and outcomes amongst patients with CKD (eGFR < 60), with at least 2 PCP visits in the year prior. A Cox proportional hazards model was used to evaluate the relationship between medication groups and overall mortality, while competing risks regression models were used to determine the risk of ESKD with death as a competing risk. Results 25,455 patients met inclusion criteria and were stratified according to medication group: no antacid therapy (15,961), PPI use (8646), or H2B use (848). At 4 years, the cumulative incidence of ESKD with death as a competing risk was 2.0% (95% CI: 1.7, 2.4), 1.5% (0.8, 2.8), and 1.6%(1.4, 1.9) among PPI, H2B, and no medication respectively (P = 0.22). The cumulative incidence of death with ESKD as a competing risk was 17.6% (95% CI: 16.6, 18.6), 16.7% (13.7, 19.8), and 17.3% (16.6, 18.0) (P = 0.71). Conclusions Use of PPI in a CKD population was not associated with increased mortality or progression to ESKD when compared to H2 blocker and to no acid suppressing therapy.

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“…15 The study done by Grant and colleagues concluded that PPI use is associated with increased risk of major adverse renal events. 16 This study is the only other study, to date, to look at PPI safety speci cally in the CKD population. However, there are several important distinctions between Grant's study and our own, which could account for the differences seen in our results.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, only one such study has been published. 16 It concluded that PPI use was associated with increased major renal adverse events, de ned as doubling of serum creatinine or progression to end-stage renal disease.…”

Section: Introductionmentioning

confidence: 99%

Proton-Pump Inhibitor vs. H2-Receptor Blocker Use and Overall Risk of CKD Progression

Cholin

Ashour

Mehdi

et al. 2020

Preprint

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Background: The relationship between proton-pump inhibitor (PPI) use and chronic kidney disease (CKD) progression remains controversial. Specifically, there is a lack of data evaluating renal outcomes in established CKD patients. The aim of our study is to determine the risk of progression to end-stage kidney disease (ESKD) or death amongst CKD patients on PPI, histamine-2 receptor blocker (H2B), or no anti-acid therapy. Methods: Using our CKD registry, we evaluated the relationship between PPI and H2B use and outcomes amongst patients with CKD (eGFR <60), with at least 2 PCP visits in the year prior. A Cox proportional hazards model was used to evaluate the relationship between medication groups and overall mortality, while competing risks regression models were used to determine the risk of ESKD with death as a competing risk.Results: 25,455 patients met inclusion criteria and were stratified according to medication group: no antacid therapy (15,961), PPI use (8,646), or H2B use (848). At 4 years, the cumulative incidence of ESKD with death as a competing risk was 2.0% (95% CI: 1.7, 2.4), 1.5% (0.8, 2.8), and 1.6%(1.4, 1.9) among PPI, H2B, and no medication respectively (P=0.22). The cumulative incidence of death with ESKD as a competing risk was 17.6% (95% CI: 16.6, 18.6), 16.7% (13.7, 19.8), and 17.3% (16.6, 18.0) (P=0.71).Conclusions: Use of PPI in a CKD population was not associated with increased mortality or progression to ESKD when compared to H2 blocker and to no acid suppressing therapy.

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Proton pump inhibitor use and progression to major adverse renal events: a competing risk analysis

Cited by 18 publications

References 31 publications

Advances in the diagnosis and management of gastroesophageal reflux disease

Advances in the diagnosis and management of gastroesophageal reflux disease

Proton-pump inhibitor vs. H2-receptor blocker use and overall risk of CKD progression

Proton-Pump Inhibitor vs. H2-Receptor Blocker Use and Overall Risk of CKD Progression

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