PPIs Associated with Increased Risk for Chronic Kidney Disease

By Kelly Young

Edited by Jaye Elizabeth Hefner, MD

Use of proton-pump inhibitors (PPIs) is associated with a 20% to 50% increased risk for developing chronic kidney disease (CKD), suggests an observational study in JAMA Internal Medicine.

In the main, population-based cohort, researchers followed over 10,000 people without CKD at baseline. Over roughly 14 years, nearly 14% developed CKD. Rates of CKD were higher among patients using PPIs at baseline, compared with nonusers (14.2 vs. 10.7 events per 1000 person-years). PPI users also had higher rates of acute kidney injury than did nonusers. Similar associations were observed in a larger replication cohort.

Dr. Thomas Schwenk, deputy editor of NEJM Journal Watch General Medicine, notes that the findings "add to increasing concerns about PPI use, including excess risks for Clostridium difficile infections, pneumonia, and fractures, and less platelet inhibition when PPIs are used concomitantly with clopidogrel." Editorialists recommend monitoring renal function and magnesium levels in patients taking PPIs, switching to H2 receptor antagonists when feasible, and not using PPIs for vague complaints of "heartburn."