JAMA study explores PPI use and increased risk of chronic kidney disease

CHICAGO - A JAMA Internal Medicine report published Monday associated the use of proton pump inhibitors with an increased risk of chronic kidney disease, but more research is needed to determine whether PPI use causes kidney damage the article stated.

 

Morgan Grams, of Johns Hopkins University, Baltimore, and coauthors quantified the association between PPI use and chronic kidney disease in the general population using data on self-reported PPI use in the Atherosclerosis Risk in Communities (ARIC) study (10,482 participants followed up for a median of nearly 14 years) or an outpatient PPI prescription in the Geisinger Health System in Pennsylvania (248,751 participants followed up for a median of six years). The results were replicated at Geisinger.

 

At baseline, PPI users in both groups were more likely to have a higher body mass index and take antihypertensive, aspirin or statin medications.

 

In the ARIC group, there were 56 incident CKD events among 322 baseline PPI users (14.2 per 1,000-person years) and 1,382 events among 10,160 baseline nonusers (10.7 per 1,000 person-years). PPI use was associated with risk of incident CKD in unadjusted and adjusted analyses. The 10-year estimated absolute risk of CKD among the 322 baseline PPI users was 11.8% while the expected risk had they not used PPIs was 8.5%, according to the results.

 

The authors did note several study limitations, however, including that participants who are prescribed PPIs may be at higher risk of CKD for reasons unrelated to their PPI use.

 

"We note that our study is observational and does not provide evidence of causality. However, a causal relationship between PPI use and CKD could have a considerable public health effect given the widespread extent of use," the study stated. "More than 15 million Americans used prescription PPIs in 2013, costing more than $10 billion. Study findings suggest that up to 70% of these prescriptions are without indication and that 25% of long-term PPI users could discontinue therapy without developing symptoms." 

 

“Currently available safety data as well as cumulative experience on the use of OTC PPIs does not warrant any revision of clinical practice or recommendations for use," noted the Consumer Healthcare Products Association in a press release published Tuesday. "The published data on any possible association needs further review and verification and does not change the well-established safe and effective proper use of PPIs."

 

Previous research from CHPA and the Nielsen Company indicates 94% patient satisfaction with OTC heartburn medications and estimates that OTC therapy saves patients an average total of $174 each in office visits and medication costs annually.