Proton Pump Inhibitor Use and Worsening Kidney Function: A Retrospective Cohort Study Including 122,606 Acid-Suppressing Users

González-Pérez, Antonio ; Martínez-Domínguez, Samuel J. (Universidad de Zaragoza) ; Lanas, Ángel (Universidad de Zaragoza) ; Lanas, Aitor ; Iñigo, Pablo (Universidad de Zaragoza) ; García-Rodríguez, Luis A.

Resumen: Background: The impact of proton pump inhibitors (PPIs) use on worsening renal function is controversial and lacks a solid pathophysiological explanation. Objective: To assess the risk of worsening renal function and acute kidney injury (AKI) in PPI initiators as compared with H2-blockers initiators. Design: Retrospective cohort study using longitudinal records from BIGAN, a population-based health database of Aragón (Spain). Participants:
PPIs (n = 119,520) and H2-blockers (n = 3,086) initiators between 2015 and 2020 with preserved renal function. They were followed until the occurrence of an adverse kidney event, death, lost to follow-up or June 2021.
Main measures: Primary endpoints were worsening kidney function (measured as sCr ≥ 2 times baseline, eGFR < 60 ml/min/1.73m2, a decrease in eGFR 30–50% from baseline or end stage renal disease) and AKI (measured by Aberdeen algorithm or hospitalization due to AKI). Incidence rates (IRs) per 1,000 persons-years were reported and Cox regression was used to calculate Hazard ratios (HRs), adjusted for confounders. Key results: Crude IRs for worsening kidney function were consistently lower for ranitidine than for PPIs (eGFR < 60 ml/min/1.73m2: IR 18.7 95%CI (12.0–27.8) for ranitidine, IR 31.2 95%CI (29.9–32.5) for omeprazole). However, the risk of incident worsening function did not significantly differ in the Cox regression analysis adjusting for confounders (HR 0.99 95%CI (0.66–1.48) for omeprazole, as compared to ranitidine). PPI initiators consistently showed lower IRs of AKI using Aberdeen algorithm (IR 33.8 95%CI (32.4–35.1) for omeprazole, IR 52.8 95%CI (40.9–67.1) for ranitidine) and lower risk of AKI (HR 0.54 95%CI (0.42–0.70) for omeprazole, as compared to ranitidine). Conclusions: No clinically relevant differences were observed for worsening kidney function between PPIs and H2-blockers initiators. PPIs users presented a reduced risk of AKI compared to ranitidine initiators. Graphical Abstract: AKI: acute kidney injury. eGFR: estimated glomerular filtrate rate. H2-blocker: Histamine 2 receptor antagonist. PPI: proton pump inhibitor. sCr: serum creatinine.

Idioma: Inglés

DOI: 10.1007/s11606-024-09213-8

Año: 2024

Publicado en: JOURNAL OF GENERAL INTERNAL MEDICINE 40 (2024), 818-827
ISSN: 0884-8734

Factor impacto JCR: 4.2 (2024)

Categ. JCR: MEDICINE, GENERAL & INTERNAL rank: 42 / 332 = 0.127 (2024) - Q1 - T1
Categ. JCR: HEALTH CARE SCIENCES & SERVICES rank: 25 / 185 = 0.135 (2024) - Q1 - T1

Factor impacto SCIMAGO: 1.992 - Internal Medicine (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)