CKD risk with tegoprazan versus proton pump inhibitors

Proton pump inhibitors (PPIs) are widely used for acid suppression but have been associated with kidney injury. Potassium-competitive acid blockers (P-CABs) such as tegoprazan provide rapid, reversible inhibition of gastric H⁺/K⁺-ATPase, yet their renal safety remains unclear. We compared the risk of incident chronic kidney disease (CKD) between tegoprazan and PPIs in a nationwide population-based cohort.

Using the Korean Health Insurance Review and Assessment database, we identified adults without prior kidney disease who initiated tegoprazan or a PPI during 2020-2021. After 1:3 propensity score matching, we compared the risk of incident CKD using Cox proportional hazards models. Sensitivity and subgroup analyses examined robustness and effect modification by age, sex, and comorbidities.

Among 901,606 new users (43,864 tegoprazan; 857,742 PPIs), PPI use was associated with a higher CKD incidence (6.16 vs 4.63 per 1,000 person-years). In the matched cohort, PPI initiation was associated with a higher risk of CKD than tegoprazan initiation (hazard ratio 1.22; 95% CI 1.09-1.37; P < 0.01). Findings were consistent across subgroups and sensitivity analyses, including the unmatched cohort (HR 1.34; 95% CI 1.20-1.48; P < 0.01).

In this large real-world analysis, PPI initiation was associated with a higher rate of newly coded CKD than tegoprazan initiation. These findings provide comparative kidney safety data and suggest that risk of kidney injury may be one consideration, alongside efficacy and cost, when prolonged acid suppression is required.