期刊
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY
卷 87, 期 7, 页码 2967-2976出版社
WILEY
DOI: 10.1111/bcp.14713
关键词
acute kidney injury; chronic kidney disease; pharmacoepidemiology; proton pump inhibitors; renal risk
资金
- Agence Nationale de la Recherche
- Agence Nationale de Securite du Medicament et des Produits de Sante
- Amgen
- AstraZeneca
- Baxter
- Fresenius Medical Care
- GlaxoSmithKline
- Lilly france
- Merck Sharp & Dohme-Chibret (MSD France)
- Otsuka Pharmaceutical
- Sanofi-Genzyme
- Vifor
Long-term use of proton pump inhibitors is common among chronic kidney disease patients, and it is associated with an increased risk of acute kidney injury, end-stage kidney disease, and all-cause mortality.
Aims: Long-term use of proton pump inhibitors (PPIs) has been associated with adverse kidney events in the general population, but their impact among chronic kidney disease (CKD) patients is unclear. We studied the prevalence and incidence (new users) of PPI prescriptions and their relation to kidney outcomes and mortality in CKD patients. Methods: We collected drug prescriptions prospectively in a cohort of 3023 nephrology outpatients with CKD stages 2-5 at inclusion. Hazard ratios (HR, 95% confidence intervals [95% CI]) for acute kidney injury (AKI), end-stage kidney disease (ESKD), and mortality associated with new PPI prescriptions as a time-dependent variable were estimated with cause-specific Cox models in 1940 non-users with eGFR >= 15 mL/min/1.73 m(2) at baseline, adjusted for comorbidities, laboratory data and drugs. Results: There were 981/3023 (32%) prevalent users (67 +/- 13 years, 65% men) at baseline, and 366/3023 (12%) were prescribed PPI (new users) over a median follow-up of 3.9 years (interquartile range, 3-4.2). Among these new users, their median cumulative duration of prescription was 1 year (interquartile range: 0.4-2.3). During follow-up, 354 patients developed ESKD and 216 died before ESKD. The adjusted HRs associated with PPI prescription were 1.74 (95% CI, 1.26-2.40) for ESKD and 2.42 (95% CI, 1.73-3.39) for all-cause mortality. Over the first 3 years of follow-up, 211 AKI events had occurred. The adjusted HR for AKI associated with PPI prescription was 2.89 (95% CI, 1.91-4.38). Conclusions: Long-term PPI prescription was common in CKD patients. Our results call attention to its potential risks of both acute and chronic kidney failure.
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