Tegoprazan and the risk of end-stage kidney disease progression: a nationwide Korean study

Background: Tegoprazan, a potassium-competitive acid blocker used in South Korea since 2018, was examined in this study for its potential association with death or progression to end-stage kidney disease (ESKD) among patients with stage 3 or 4 chronic kidney disease (CKD) prescribed tegoprazan for more than 90 days. Methods: This real-world, retrospective study used national claims data from South Korea recorded between 2013 and 2022. Three independent pairwise analyses were conducted after 1:1 propensity score matching (PSM), comparing the risks of death or ESKD progression between CKD-tegoprazan and CKD-histamine 2 receptor agonists (H2RAs), CKD-tegoprazan and CKD-proton pump inhibitors (PPIs), and CKD-PPIs and CKD-H2RAs. Each outcome was compared using a Cox proportional hazards model, and results were combined in a network meta-analysis. Results: After PSM, 674, 902, and 4,583 pairs of patients' data were available for each analysis, respectively. Nearly 50% of patients were aged 75 or older. More than 85%, 45%, and 28% of the patients had hypertension, diabetes, and ischemic heart disease, respectively, and approximately 70% were prescribed an antithrombotic agent. The risk of death or ESKD was not increased in the CKD-tegoprazan cohort compared to CKD-H2RA (hazard ratio, 0.91 [95% confidence interval, 0.66-1.26]; p = 0.57) or CKD-PPIs (hazard ratio, 0.87 [95% confidence interval, 0.66-1.15]; p = 0.32). Network meta-analysis yielded the same trends. Conclusion: In patients with stage 3 or 4 CKD and multiple risk factors for ESKD progression, using tegoprazan for a minimum of 90 days did not increase the risk of death or ESKD progression.