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Abstract: TH-PO968

Effects of Pantoprazole on Kidney Outcomes: Post Hoc Analyses From the COMPASS Randomized Controlled Trial

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

  • Pyne, Lonnie, Population Health Research Institute, Hamilton, Ontario, Canada
  • Smyth, Andrew, Population Health Research Institute, Hamilton, Ontario, Canada
  • Molnar, Amber O., Population Health Research Institute, Hamilton, Ontario, Canada
  • Moayyedi, Paul, Population Health Research Institute, Hamilton, Ontario, Canada
  • Yusuf, Salim, Population Health Research Institute, Hamilton, Ontario, Canada
  • Eikelboom, John, Population Health Research Institute, Hamilton, Ontario, Canada
  • Bosch, Jackie, Population Health Research Institute, Hamilton, Ontario, Canada
  • Walsh, Michael, Population Health Research Institute, Hamilton, Ontario, Canada
Background

The effect of proton pump inhibitors (PPIs) on kidney function is uncertain. We assessed the effect of pantoprazole on long term kidney function using data from the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial.

Methods

COMPASS was a placebo-controlled, partial factorial randomized controlled trial that randomized 17,598 participants with chronic atherosclerotic vascular disease, not taking a proton pump inhibitor, to pantoprazole 40 mg daily or placebo (in addition to aspirin,
aspirin and rivaroxaban, or rivaroxaban alone). Our primary outcome was the mean rate of change of estimated glomerular filtration rate (eGFR) in participants with eGFR recorded at baseline and at entry to the long-term, open label extension (LTOLE). Secondary outcomes included the risk of chronic kidney disease (eGFR <60 ml/min/1.73 m2 ), acute kidney injury (AKI), acute nephritis, and nephrotic syndrome.

Results

8,991 participants had an eGFR recorded at baseline and the beginning of LTOLE and were included in the rate of eGFR change population. Over a mean follow-up of 3.4 years, the mean rate of eGFR change in the placebo group was -1.37 (standard deviation [SD] 4.29) ml/min/1.73 m2 per year. The mean rate of eGFR change in the pantoprazole group was -1.59 (SD 4.27) ml/min/1.73 m2 per year. The pantoprazole group had a 0.26 ml/min/1.73 m2 per year greater decline in mean eGFR as compared to the placebo group (95% CI 0.10 to 0.41, p=0.002). The adjusted odds ratio for the effect of pantoprazole on incident CKD was 1.11 (95% CI 0.98 to 1.25, p=0.09) and on AKI was 0.89 (95% CI 0.65 to 1.21, p=0.441).

Conclusion

Pantoprazole resulted in a greater rate of eGFR decline as compared to placebo. The clinical importance of this effect is uncertain.

Mean rate of eGFR change (ml/min/1.73 m2 per year) pantoprazole as compared to placebo by subgroup and overall population.

Funding

  • Commercial Support