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ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

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Kidney Week

Abstract: TH-PO452

The Effect of Proton Pump Inhibitor Use on the Development of Metabolic Acidosis and Decline in Kidney Function in Patients with CKD Stages G3a to G4

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Giusti, Sixto G., Tulane University, New Orleans, Louisiana, United States
  • Lin, Yilu, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Liu, Shuqian, Tulane University, New Orleans, Louisiana, United States
  • Nakhoul, Nazih L., Tulane Medical School, New Orleans, Louisiana, United States
  • Shi, Lizheng, Tulane University, New Orleans, Louisiana, United States
  • Batuman, Vecihi, Tulane University, New Orleans, Louisiana, United States

Proton Pump Inhibitors (PPI) block H+, K+ - ATPase and are widely used for the treatment of GERD and PUD. H+-K+ ATPase is present in other organs, including the kidneys. Metabolic acidosis (MA) can hasten progression of kidney disease. We evaluated the relation between chronic PPI use in patients with CKD Stages G3a to G4, the development of MA, and the rate of decline in renal function. We hypothesized that CKD patients who have been on PPI for at least one year would have a higher prevalence of MA and faster progression of CKD compared to patients not on PPI therapy.


We extracted data of patients from the VA Informatics and Computing Infrastructure national database system. We included adult patients with CKD (eGFR <60 ml/min1.73m2) and a record of receiving care for at least 5 yrs at the VA starting on January 1, 1999, through May 31, 2018. We excluded patients on dialysis, patients that transitioned to renal transplant, or death. Our outcome measures included mean serum bicarbonate and progression of CKD, measured by the decline in GFR determined by the MDRD formula. We applied Propensity Score Matching to match the PPI group and the control group on age, sex, race, and Charlson Comorbidity Index. Kaplan-Meier curve & Cox regression were performed to analyze the associations of PPI use with MA, dialysis, all-cause mortality, and CKD progression (defined as a 10 unit decrease of eGFR from the baseline eGFR).


The final sample included 1406 patients (age: 62.07±7.82, 62.02% of white) in PPI cohort with a median 4.7 yrs follow-up, and 573 patients (age: 63.25±7.00, 70.33% of white) in no-PPI cohort with a median 4.2 yrs follow-up. When compared to the no-PPI cohort, the PPI group had a significantly increased risk of CKD progression and dialysis (aHR, 1.43; 95% CI, 1.17 to 1.74; and aHR, 1.69; 95% CI, 1.03 to 2.77, respectively). Patients on PPI also had a higher risk of MA (aHR, 1.83; 95% CI, 0.88 to 3.82) and all-cause mortality (aHR, 1.25; 95% CI, 0.96 to 1.64), but these differences were not statistically significant.


The data suggest that chronic PPI accelerates progression of kidney disease in CKD patients. Chronic PPI use should be discouraged in this population.


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