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Associations of Proton-Pump Inhibitors and H2 Receptor Antagonists with Chronic Kidney Disease: A Meta-Analysis

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Abstract

Background/Aims

The aim of this meta-analysis was to assess the risks of chronic kidney disease (CKD) and/or end-stage kidney disease (ESRD) in patients who are taking proton-pump inhibitors (PPIs) and/or H2 receptor antagonists (H2RAs).

Methods

Comprehensive literature review was conducted utilizing MEDLINE and EMBASE databases through April 2017 to identify all studies that investigated the risks of CKD or ESRD in patients taking PPIs/H2RAs versus those without PPIs/H2RAs. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this study is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017067252).

Results

Five studies with 536,902 participants were patients were identified and included in the data analysis. When compared with non-PPIs users, the pooled risk ratio (RR) of CKD or ESRD in patients with PPI use was 1.33 (95% CI 1.18–1.51). Pre-specified subgroup analysis (stratified by CKD or ESRD status) demonstrated pooled RRs of 1.22 (95% CI 1.14–1.30) for association between PPI use and CKD and 1.88 (95% CI 1.71–2.06) for association between PPI use and ESRD, respectively. However, there was no association between the use of H2RAs and CKD with a pooled RR of 1.02 (95% CI 0.83–1.25). When compared with the use of H2RAs, the pooled RR of CKD in patients with PPI use was 1.29 (95% CI 1.22–1.36).

Conclusions

Our study demonstrates statistically significant 1.3-fold increased risks of CKD and ESRD in patients using PPIs, but not in patients using H2RAs.

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Authors and Affiliations

  1. Department of Internal Medicine, Bassett Medical Center, One Atwell Road, Cooperstown, NY, 13326, USA

    Karn Wijarnpreecha & Charat Thongprayoon

  2. Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Supavit Chesdachai

  3. Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Panadeekarn Panjawatanana

  4. Division of Rheumatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Patompong Ungprasert

  5. Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA

    Wisit Cheungpasitporn

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  1. Karn Wijarnpreecha
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  2. Charat Thongprayoon
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  3. Supavit Chesdachai
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  4. Panadeekarn Panjawatanana
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  5. Patompong Ungprasert
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Correspondence to Charat Thongprayoon.

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Wijarnpreecha, K., Thongprayoon, C., Chesdachai, S. et al. Associations of Proton-Pump Inhibitors and H2 Receptor Antagonists with Chronic Kidney Disease: A Meta-Analysis. Dig Dis Sci 62, 2821–2827 (2017). https://doi.org/10.1007/s10620-017-4725-5

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  • DOI: https://doi.org/10.1007/s10620-017-4725-5

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