Individuals who take proton pump inhibitors (PPIs) are at increased risk of kidney damage, according to a large population-based study.

Investigators at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences in Buffalo, New York, found that patients who used PPIs had a significant 4-fold increased risk of acute kidney injury (AKI) and 1.2-fold increased risk of chronic kidney disease (CKD) compared with nonusers, in adjusted analyses.

“This relationship could have considerable public health impact; therefore, health care provider education and deprescribing initiatives will be necessary to raise awareness and reduce health care burden,” a team led by David M. Jacobs, PharmD, PhD, concluded in a paper published in Pharmacotherapy.

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The study included 93,335 patients with AKI and 84,600 patients with CKD receiving care at a large population-based health maintenance organization. Of the patients in the AKI and CKD cohorts, 16,593 and 14,514 used PPIs, respectively. The incidence rate of AKI was significantly higher among PPI users than nonusers (36.4 vs 3.54 per 1000 person-years), Dr Jacobs and his collaborators reported. The incidence rate of CKD was significantly higher among the PPI users than nonusers (34.3 vs 8.75 per 1000 person-years).

Patients with AKI were followed for up to 90 days, and patients with CKD required at least 1 year of follow-up.

The latest study adds to mounting evidence of a link between PPI user and development of AKI and CKD. For example, a systematic review and meta-analysis published in Drug Design, Development and Therapy in 2017 found that PPI use was associated with a significant pooled 61% increased relative risk of AKI. The meta-analysis included 513,696 cases of PPI use among 2,404,236 participants in 5 cohort studies and 2 case-control studies. In a 2017 paper published in Kidney International, investigators reported on a study showing that PPI users had a 26% increased risk of CKD compared with patients who took H2 blockers. In addition, PPI users were 22% more likely to experience CKD progression.


Hart E, Dunn TE, Feuerstein S, Jacobs DM. Proton pump inhibitors and risk of acute and chronic kidney disease: a retrospective cohort study. Pharmacotherapy. 2019; published online ahead of print.