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Kidney Week

Abstract: PO0441

Proton-Pump Inhibitors (PPIs) vs. H2 Blockers (H2B) Users and Overall Risk of CKD Progression

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Cholin, Liza, Cleveland Clinic, Cleveland, Ohio, United States
  • Ashour, Tarek, Cleveland Clinic, Cleveland, Ohio, United States
  • Mehdi, Ali, Cleveland Clinic, Cleveland, Ohio, United States
  • Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
  • Daou, Remy, Universite Saint-Joseph, Beirut, Lebanon
  • Arrigain, Susana, Cleveland Clinic, Cleveland, Ohio, United States
  • Schold, Jesse D., Cleveland Clinic, Cleveland, Ohio, United States
  • Nakhoul, Nazih L., Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Nakhoul, Georges, Cleveland Clinic, Cleveland, Ohio, United States
Background

PPI use is associated with adverse kidney events. The relationship between PPI use and the development of acute interstitial nephritis (AIN) is well established. However, the relationship between PPI use and CKD progression is less clear. Notably, there is a lack of data concerning renal outcomes in established CKD patients. The aim of our study is to determine the risk of CKD progression amongst CKD patients on PPI, H2B, or no anti-acid therapy.

Methods

Using our CKD registry, we evaluated the relationship between the use of PPI and H2B and outcomes among patients with CKD stage 3 and 4 with at least 2 PCP visits in the year prior. We evaluated the relationship between medication group and overall mortality using a Cox proportional hazards model while adjusting for demographics and comorbidities, and the relationship between medication group and progression to eGFR<20 or ESKD with death as a competing risk using regression models as described by Fine and Gray.

Results

Among 3,930 patients, 1,374 were in PPI group, 119 were in H2 blocker group, and 2,437 were on no medication. Average age was 72.8+11.1, and 42.5% male. Among PPI 28% had Coronary Artery Disease compared to 22% among H2B and 19% among no medication (P<0.001). Congestive Heart Failure was 13%, 8% and 7% for each group respectively (P < 0.01). Overall mortality was not different amongst the three groups (PPI vs. none HR 0.94, 95% CI: 0.80, 1.10, and PPI vs. H2B HR 0.80, 95% CI: 0.52, 1.24). The cumulative incidence of ESKD/eGFR<20 with death as a competing risk was also not different across groups in univariate (Fig. 1) or adjusted models (PPI vs. none SHR 0.99, 95% CI: 0,74, 1.34, PPI vs. H2B SHR 1.82, 95% CI: 0.91, 3.63).

Conclusion

Use of PPI in a CKD population was not associated with increased mortality or CKD progression to ESKD when compared to the use of H2 blockers and to no acid suppressing therapy.