Proton pump inhibitors use and risk of chronic kidney disease: Evidence-based meta-analysis of observational studies

Introduction Proton pump inhibitors (PPIs) are one of the widely used drugs available as over the counter for treatment of acid-related gastrointestinal disorders. Concerns have been raised about the risk of developing chronic kidney disease (CKD) with the prolonged use of PPIs. This meta-analysis aims to determine the association between PPI use and risk of developing CKD. Methods The methodology complies with our registered protocol at PROSPERO (CRD42016040073). PubMed and Embase were searched from inception to 27th September 2017. Two reviewers independently screened and selected the observational studies comparing CKD outcome in patients on PPI. The quality of selected studies was assessed using Newcastle-Ottawa Scale. Subgroup and sensitivity analysis were also performed. All the analysis was performed by using RevMan v5.3. Results The 6 included studies comprised of 4 cohorts and 2 case-control studies with 720758 patients from cohort and 84078 patients from the case-control study. All the studies were of highest quality. Overall pooled relative risk (RR) of developing CKD was 1.32(95% CI 1.19 to 1.46), ( p -value=<0.00001) and for end-stage renal disease (ESRD) RR was 1.88 (95% CI: 1.71 to 2.07), ( p =<0.00001) in patients receiving PPI. The higher incidence of CKD was seen in diabetic patients taking PPI with RR of 1.82 (95% CI 1.22 to 1.72), (p-value=0.004). Conclusion An association between proton pump inhibitor use and risk of developing chronic kidney disease and ESRD was found in the study.