Kidney Week

Abstract: SA-PO1125

Association Between Discontinuation of Proton-Pump Inhibitors and Kidney Outcome Among Patients with CKD: The OCKR Study

Session Information

• CKD: Progression, Drugs, Modalities, and Environmental Factors
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Kawano, Yuki, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka Prefecture, Japan

Yuki Kawano, MD

• Sakaguchi, Yusuke, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka Prefecture, Japan

Yusuke Sakaguchi, MD, PhD

• Kadono, Hikaru, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka Prefecture, Japan

Hikaru Kadono, MD

• Sugimachi, Ayaka, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka Prefecture, Japan

Ayaka Sugimachi, MD

• Uwatoko, Ryuta, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka Prefecture, Japan

Ryuta Uwatoko, MD

• Fukuda, Shungo, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka Prefecture, Japan

Shungo Fukuda, MD

• Oka, Tatsufumi, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka Prefecture, Japan

Tatsufumi Oka, MD, PhD

• Matsui, Isao, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka Prefecture, Japan

Isao Matsui, MD, PhD

• Mizui, Masayuki, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka Prefecture, Japan

Masayuki Mizui, MD, PhD

• Kaimori, Jun-Ya, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka Prefecture, Japan

Jun-Ya Kaimori, MD

• Isaka, Yoshitaka, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka Prefecture, Japan

Yoshitaka Isaka, MD, PhD

Background

Proton pump inhibitors (PPIs), one of the most widely used medications, are known to be associated with adverse kidney outcomes. In clinical practice, however, long-term PPI use without a clear indication is common. It remains unclear whether discontinuing PPIs could reduce the risk of kidney failure in patients who initiated PPIs. Using a causal inference approach, we investigated the potential benefits of discontinuing PPI on kidney prognosis.

Methods

The Osaka Consortium for Kidney Disease Research (OCKR) is a retrospective, multicenter cohort study that includes patients who attended the nephrology outpatient departments at five hospitals in Osaka, Japan, from January 2005 to December 2021. For this analysis, we included PPI-naïve patients with an estimated glomerular filtration rate (eGFR) of 10–60 mL/min/1.73 m². The primary outcome was kidney failure with replacement therapy (KFRT). We examined the association of PPI use with KFRT using marginal structural models to account for potential time-dependent confounding factors. Furthermore, we compared the risk of KFRT between discontinuing PPIs within 90 days after initiation and continuing PPIs, using a clone-censor-weighting approach.

Results

Among the 14,796 patients included in this analysis, the mean age and eGFR at baseline were 69 years and 35 mL/min/1.73 m², respectively, and 60% were male. Over a median (IQR) follow-up of 2.7 (0.9–5.8) years, 4,187 patients (28.3%) initiated PPI therapy, and 1,593 patients (10.8%) developed KFRT. After adjusting for potential confounders, PPI use was significantly associated with a higher hazard of KFRT (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.03–1.55). Of those who initiated PPI therapy, 1,254 patients (30.0%) discontinued PPIs within 90 days. Discontinuing PPIs was significantly associated with a 22% lower risk of KFRT (95% CI, 8–33) compared to continuing PPIs.

Conclusion

The increased risk of KFRT associated with PPI use may be reduced by discontinuing these drugs within 90 days.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025c4y3mz7a