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PPI Use and Increased Risk of Chronic Kidney Disease

11 August 2018


Background: Proton pump inhibitors (PPIs) are a class of gastric-acid reducing medications indicated for conditions including gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), Zollinger-Ellison syndrome, and erosive esophagitis. With 119 million PPI prescriptions filled in 2009, these are currently one of the most commonly prescribed classes of medication. The current list of known side effects for PPIs includes pneumonia, Clostridium difficile, hip fractures, acute interstitial nephritis (AIN), and malabsorption. The purpose of this review is to investigate if PPI use is also associated with an increased risk in developing chronic kidney disease (CKD)

Methods: An exhaustive literature search using 3 search engines: Web of Science, MEDLINE-PubMed, and CINAHL databases. Key phrases used included: “proton pump inhibitors” and “chronic kidney disease”. Articles were assessed for quality using GRADE criteria.

Results: Four articles met eligibility criteria and were included in this systematic review. All four were observational studies. Within each study, it was determined that those taking a PPI were at an increased risk in developing CKD versus those not taking one. Three of the 4 articles were downgraded to very low, and one was graded as low.

Conclusion: PPI use appears to have an association with an increased risk in developing CKD. Providers should only prescribe PPIs when indicated and may want to try H2 blockers first to see if this helps the patient’s condition before progressing to a PPI. In order to determine a stronger association between PPI use and the development of CKD, further research needs to be conducted.

Keywords: Chronic kidney disease, proton pump inhibitor


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