Proton Pump Inhibitors and Risk of Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Area of Science:

• Nephrology
• Pharmacology
• Epidemiology

Background:

• Proton pump inhibitors (PPIs) are frequently prescribed for acid-related gastrointestinal disorders.
• Emerging evidence suggests a potential link between prolonged PPI use and the development of chronic kidney disease (CKD).

Purpose of the Study:

• To systematically review and meta-analyze observational studies evaluating the association between PPI use and the risk of CKD, CKD progression, and end-stage renal disease (ESRD).

Main Methods:

• A comprehensive literature search identified 15 observational studies involving adult PPI users.
• Data on renal outcomes and adverse events were extracted.
• Random-effects models were used for meta-analysis, with heterogeneity and publication bias assessed.

Main Results:

• Meta-analysis of six studies (n=594,680) revealed a significantly increased risk of incident CKD with PPI use (RR=1.68).
• Four studies (n=149,702) showed a significant increase in the risk of ESRD among PPI users (RR=1.15).
• The risk of CKD progression was higher but not statistically significant (RR=1.49). Hypomagnesemia and acute kidney injury were more frequent in PPI users.

Conclusions:

• Proton pump inhibitor therapy is associated with an increased risk of developing CKD and ESRD.
• A potential link to CKD progression exists but requires further investigation.
• Clinicians should judiciously prescribe long-term PPIs, confirm indications, and monitor kidney function in chronic users.