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

• Published in: BMC nephrology Vol. 22; no. 1; p. 264
• Main Authors: Cholin, Liza, Ashour, Tarek, Mehdi, Ali, Taliercio, Jonathan J, Daou, Remy, Arrigain, Susana, Schold, Jesse D, Thomas, George, Nally, Joseph, Nakhoul, Nazih L, Nakhoul, Georges N
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15.07.2021; BioMed Central; BMC
• Subjects: Cardiovascular disease; Chronic kidney disease; Chronic kidney failure; Comorbidity; Comparative analysis; Continuity of care; Creatinine; Datasets; Death; Development and progression; Diabetes; Disease Progression; Drug therapy; Electronic health records; End-stage renal disease; Female; Hemoglobin; Histamine H2 Antagonists - administration & dosage; Histamine H2 Antagonists - adverse effects; Histamine H2 receptors; Histamine-2 receptor blockers; Humans; Hypertension; Incidence; Kaplan-Meier Estimate; Kidney diseases; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - mortality; Laboratories; Male; Middle Aged; Mortality; Negative Results; Nephrology; Outcome Assessment, Health Care; Patients; Potassium; Prescriptions; Proportional Hazards Models; Proton pump inhibitors; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - adverse effects; Registries - statistics & numerical data; Regression analysis; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Risk Assessment; Risk factors; Stomach Diseases - drug therapy; Stomach Diseases - epidemiology; United States - epidemiology; United States; United States > US; Ohio; Chronic kidney disease; Histamine-2 receptor blockers; Proton-pump inhibitors; Mortality; Disease progression
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-021-02449-0

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. 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. 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). 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.