Proton Pump Inhibitors and Risk of Chronic Kidney Disease: A Systematic Review and Meta-Analysis
Abstract
Proton pump inhibitors (PPIs) are widely prescribed for acid-related disorders, yet growing evidence suggests a potential association between long-term PPI use and chronic kidney disease (CKD). This systematic review and meta-analysis aimed to evaluate the risk of CKD, disease progression, and end-stage renal disease (ESRD) among PPI users compared with nonusers or histamine-2 receptor antagonist users. A comprehensive search identified observational studies assessing renal outcomes among adult PPI users. Fifteen studies met the inclusion criteria, representing diverse populations across Asia, Europe, and the United States. Data on CKD incidence, progression, ESRD, and additional adverse effects were extracted. Pooled effect estimates were calculated using random-effects models. Heterogeneity, sensitivity analyses, and publication bias were evaluated using I², leave-one-out testing, and funnel plots. Our review included 15 studies, with sample sizes ranging from 3,023 to 462,421 participants. Meta-analysis of six studies (n = 594,680) demonstrated a significantly increased risk of incident CKD among PPI users (RR = 1.68, 95% CI: 1.20-2.34; p = 0.002; I² = 99%). Two studies (n = 171,583) assessing CKD progression showed a higher, but statistically nonsignificant, risk with PPI use (RR = 1.49, 95% CI: 0.84-2.65; p = 0.17; I² = 99.3%). Four studies (n = 149,702) examining ESRD found a modest yet significant increase in risk among PPI users (RR = 1.15, 95% CI: 1.00-1.32; p =…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 594,680 participants or records.
Read the paper
Related studies
- Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials
- Tocilizumab in patients with severe COVID-19: a retrospective cohort study
- A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study
- Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study
- Are noise and air pollution related to the incidence of dementia? A cohort study in London, England
- Long COVID symptoms and duration in SARS-CoV-2 positive children — a nationwide cohort study
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.