GONZÁLEZ PÉREZ, ANTONIO, Martinez-Dominguez, Samuel J. , Lanas, Angel , Lanas, Aitor , Inigo, Pablo , Garcia-Rodriguez, Luis A.

No

J. Gen. Intern. Med.

Article

Científica

✓

✓

01/03/2025

001369431200001

10.1007/s11606-024-09213-8

Background: The impact of proton pump inhibitors (PPIs) use on worsening renal function is controversial and lacks a solid pathophysiological explanation. Objective: To assess the risk of worsening renal function and acute kidney injury (AKI) in PPI initiators as compared with H2-blockers initiators. Design: Retrospective cohort study using longitudinal records from BIGAN, a population-based health database of Arag & oacute;n (Spain). Participants: PPIs (n = 119,520) and H2-blockers (n = 3,086) initiators between 2015 and 2020 with preserved renal function. They were followed until the occurrence of an adverse kidney event, death, lost to follow-up or June 2021. Main measuresPrimary endpoints were worsening kidney function (measured as sCr >= 2 times baseline, eGFR < 60 ml/min/1.73m(2), a decrease in eGFR 30-50% from baseline or end stage renal disease) and AKI (measured by Aberdeen algorithm or hospitalization due to AKI). Incidence rates (IRs) per 1,000 persons-years were reported and Cox regression was used to calculate Hazard ratios (HRs), adjusted for confounders. Key results: Crude IRs for worsening kidney function were consistently lower for ranitidine than for PPIs (eGFR < 60 ml/min/1.73m(2): IR 18.7 95%CI (12.0-27.8) for ranitidine, IR 31.2 95%CI (29.9-32.5) for omeprazole). However, the risk of incident worsening function did not significantly differ in the Cox regression analysis adjusting for confounders (HR 0.99 95%CI (0.66-1.48) for omeprazole, as compared to ranitidine). PPI initiators consistently showed lower IRs of AKI using Aberdeen algorithm (IR 33.8 95%CI (32.4-35.1) for omeprazole, IR 52.8 95%CI (40.9-67.1) for ranitidine) and lower risk of AKI (HR 0.54 95%CI (0.42-0.70) for omeprazole, as compared to ranitidine). Conclusions: No clinically relevant differences were observed for worsening kidney function between PPIs and H2-blockers initiators. PPIs users presented a reduced risk of AKI compared to ranitidine initiators.

acid-suppressing drugs; proton pump inhibitors; H2-blockers; renal function; chronic kidney disease