Proton Pump Inhibitor Use and Worsening Kidney Function: A Retrospective Cohort Study Including 122,606...

Area of Science:

• Nephrology
• Pharmacology
• Epidemiology

Background:

• The association between proton pump inhibitor (PPI) use and declining kidney function remains controversial, lacking clear pathophysiological evidence.
• Existing research presents conflicting findings regarding the renal safety of PPIs.

Purpose of the Study:

• To evaluate the risk of worsening kidney function and acute kidney injury (AKI) in patients initiating PPIs versus H2-blockers.
• To compare the incidence of adverse renal events between these two drug classes.

Main Methods:

• A retrospective cohort study utilized longitudinal data from the BIGAN health database in Aragón, Spain.
• 119,520 PPI initiators and 3,086 H2-blocker initiators with preserved renal function were followed from 2015 to 2021.
• Worsening kidney function and AKI were primary endpoints, analyzed using incidence rates and Cox regression for adjusted Hazard Ratios (HRs).

Main Results:

• While crude incidence rates for worsening kidney function were lower with ranitidine (an H2-blocker) than PPIs, adjusted Cox regression revealed no significant difference (HR 0.99).
• PPI initiators demonstrated significantly lower incidence rates and risk of acute kidney injury (AKI) compared to ranitidine initiators (HR 0.54).

Conclusions:

• No clinically significant differences in worsening kidney function were found between PPI and H2-blocker initiators.
• PPI use was associated with a reduced risk of acute kidney injury (AKI) compared to ranitidine initiation.