Proton pump inhibitors (PPI) have been associated with acute kidney injury and recent studies suggest that they may be associated with the risk of chronic kidney disease (CKD).
Dr Juan Carrero and colleagues from Sweden performed a retrospective analysis using the Stockholm creatinine measurements database, which contains information on diagnoses, dispensation claims, and laboratory test results for all citizens in the Stockholm region from 2007 through 2010.
The team identified new users of PPIs and new users of H2 blockers.
Data on renal outcomes were collected for about 3 years.
The team's primary outcome was progression CKD, defined as doubling of creatinine or decrease in estimated glomerular filtration rate of 30% or more.
|Users of PPIs had an increased risk for doubled levels of creatinine|
Secondary outcomes were end-stage renal disease and acute kidney injury.
Complete collection of repeated PPI and H2B dispensations at pharmacies in Sweden allowed modeling the time-dependent risk associated with cumulative PPI exposure.
The researchers found that users of PPIs, compared with users of H2Bs, had an increased risk for doubled levels of creatinine, and decrease in estimated glomerular filtration rate of 30% or more.
The team found that PPI use also associated with development of end-stage renal disease and acute kidney injury.
There was a graded association between cumulative exposure to PPIs and risk of CKD progression.
This was not the case for cumulative H2B use.
Dr Carrero's team concludes, "Initiation of PPI therapy and cumulative PPI exposure is associated with increased risk of CKD progression in a large, North European healthcare system."
"Although consistent, the association was modest in magnitude, and cannot exclude residual confounding."