• Sixto Giusti, Yilu Lin, Folarin Sogbetun, Nazih Nakhoul, Shuqian Liu, Lizheng Shi, and Vecihi Batuman.
• Tulane University School of Medicine, Deming Department of Medicine, Section of Nephrology, New Orleans, Louisiana; Southeast Louisiana Veterans Health Care System, Medicine Service, Section of Nephrology, New Orleans, Louisiana. Electronic address: sgiustitorres@tulane.edu.
• Am. J. Med. Sci. 2021 Nov 1; 362 (5): 453-461.

BackgroundProton pump inhibitors (PPI) are widely used and implicated in the progression of chronic kidney disease (CKD). We evaluated the relation between chronic PPI use in veterans with CKD G3a to G4 and the rate of decline in renal function.MethodsWe accessed the Veteran Affairs Informatics and Computing Infrastructure national database to evaluate the relation between chronic PPI use and rate of decline in renal function in veterans with CKD (eGFR <60 ml/min1.73 m2). We applied Propensity Score Matching to match the PPI group and the no-PPI control group on age, sex, race, and Charlson Comorbidity Index. The final sample included 1406 patients (age: 62.07±7.82, 62.02% Caucasian) in the PPI cohort with a median 4.7 years follow-up and 1425 patients (age: 65.45±6.58, 71.16% Caucasian) in the control cohort with a median 3.9 years follow-up. Kaplan-Meier curve and Cox regression were performed to analyze the associations of PPI use with dialysis, all-cause mortality, metabolic acidosis, and CKD progression.ResultsThe PPI group had a significantly increased risk of CKD progression, dialysis and all-cause mortality (aHR, 1.83; 95% CI, 1.53 to 2.19; aHR, 1.84; 95% CI, 1.26 to 2.67; and aHR, 1.34; 95% CI, 1.08 to 1.65, respectively). The PPI cohort also had a trend for development of metabolic acidosis (aHR, 1.34; 95% CI, 0.998 to 1.80), although the difference was not statistically significant.ConclusionsThe data suggest that chronic PPI use accelerates progression of kidney disease and is associated with increased mortality in CKD patients.Published by Elsevier Inc.

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