PPIs and H2 Blockers Linked to Kidney Stones, Chronic Kidney Disease
Pietro Manuel Ferraro, MD, Fondazione Policlinico Universitario A. Gemelli - Catholic University of the Sacred Heart, Rome, Italy, and colleagues examined information on 187,330 participants of the Health Professionals Follow-up Study (HPFS) and Nurses’ Health Study (NHS) I and II who were initially free of kidney stones.
During a follow-up of up to 12 years for PPIs and 26 years for H2 blockers, 3,245 symptomatic kidney stones developed. After adjusting for a number of factors such as age, race, body mass index, physical activity, smoking status, comorbidities, use of medications, and intake of nutrients, use of PPIs was associated with a 12% higher risk of developing a kidney stone, and use of H2 blockers with a 13% higher risk.
In a subgroup of participants, use of PPIs was associated with lower urinary excretion of calcium, oxalate, citrate, and magnesium.
“Use of PPIs and H2 blockers is associated with a small increase in risk of incident kidney stones. Further studies are needed to confirm our findings and to investigate whether the excess risk is related to a particular type of kidney stones such as those made of calcium oxalate,” said Dr. Ferraro.
In a second study, Yan Xie, VA Saint Louis Health Care System, St. Louis, Missouri, and colleagues examined current assumptions that chronic kidney disease (CKD) that may arise after use of PPIs is secondary to incomplete recovery from acute kidney injury (AKI). When the investigators analysed information in the Department of Veterans Affairs national database on 152,157 users of PPIs or H2 blockers, PPI use was associated with a greater than 30% higher risk of developing CKD or a combined endpoint of kidney failure or more than 50% decline in estimated glomerular filtration rate compared with H2 blocker use in the absence of AKI.
“Reliance on AKI as a marker of potential adverse renal events in those treated with PPI is not sufficient,” said Xie “Exercising vigilance in PPI use -- even in the absence of AKI -- and careful attention to kidney function in PPI users may be a reasonable approach.”
SOURCE: American Society of Nephrology
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