XieY and others of St. Louis Health Care System in the United States conducted a national cohort study using the database of the Department of Veterans Affairs, and found that long-term use of PPI would increase the risk of adverse outcomes of chronic kidney disease without AKI. Related research results were published in the latest issue of Children's International magazine.
The subjects were new patients who took PPI or histamine H2 receptor antagonist H2RA for the first time, and had no basis of renal disease (defined as baseline estimated glomerular filtration rate EGFR >；; 60ml/min/1.73m2). A total of 144032 new patients with acid inhibition were registered, including PPI group 125596 and H2RA group 18436. The baseline characteristics of the two groups were similar. Patients in PPI group are often accompanied by diabetes, chronic lung diseases, hyperlipidemia, cardiovascular diseases and gastrointestinal diseases.
The model was used to analyze the adverse outcome indicators of chronic kidney disease, including eGFR30%, ESRD or eGFR decrease >: 50%, etc. Follow-up for at least 5 years.
The main results of this study are as follows:
1. At the end of the follow-up, there were no AKI patients 1 18793 cases, including PPI group 102692 cases and H2RA group16/kloc-0 cases. The incidence of AKI in proton pump inhibitor group and H2RA group were 65438 08.24% and 65438 02.67% respectively. The total incidence of adverse outcomes of chronic kidney disease was 66. 10%, the incidence rates of PPI group and H2RA group were 68. 14% and 52. 14% respectively, and the incidence rates of non-AKI group were 410/0% and 30% respectively.
2. In the new patients receiving acid suppression therapy, eGFR decreased by 30%, and the risk of adverse outcomes such as ESRD or eGFR in PPI group was significantly higher than that in H2RA group. According to the latest eGFR at the end of follow-up, the prognosis of chronic kidney disease was confirmed. In PPI group, the eGFR was 30%, with the ratio of decreasing >: increasing by 50%.
3. Among the patients with chronic kidney disease without AKI before follow-up, the survival model analysis showed that eGFR in PPI group decreased by 30%, and ESRD or EGFR >；; 50% higher risk than H2RA Group. During the whole follow-up period, the risk of adverse outcome of chronic kidney disease in PPI group also increased.
In addition, among the patients (132,699 cases) who had no history of AKI in the first five years of the cohort study, the analysis showed that PPI group had an increased risk of chronic kidney disease outcome compared with H2RA group.
4.4 Proportion mediated by PPI effect. When eGFR decreased by 30%, ESRD or eGFR, AKI was 44.7%, 45.47%, 46.00% and 46.72% respectively. The longer you take PPI, the greater the risk of adverse consequences of chronic kidney disease.
5. The test of the relationship between PPI and AKI shows that PPI can increase the risk of AKI (HR 1.47).
In a word, the adverse outcome of chronic kidney disease caused by PPI has nothing to do with AKI event. The history of AKI can increase the risk of AKI recurrence and CKD, but PPI is significantly related to the risk of CKD and ESRD in patients without AKI. It is not enough to rely on previous AKI or acute interstitial nephritis as an early warning signal to monitor the occurrence and development of adverse outcomes of chronic kidney disease in PPI patients as a single risk mitigation strategy.
Therefore, it may be a more appropriate method to be alert to long-term PPI users, especially in the absence of AKI, and to closely monitor the renal function of PPI users.