Renal Outcomes With Potassium-Competitive Acid Blockers Versus Proton Pump Inhibitors in CKD
Abstract
Introduction: Potassium-competitive acid blockers (P-CABs) have emerged as a promising alternative to proton pump inhibitors (PPIs) because of their rapid and sustained acid suppression. However, their renal safety in patients with chronic kidney disease (CKD) has not been thoroughly evaluated. Given concerns about PPI-associated renal risks, we conducted a target trial-emulated cohort study to compare renal safety of P-CABs versus PPIs.
Methods: Using Korean National Health Insurance data, we identified patients with CKD newly initiating P-CABs or PPIs for gastroesophageal reflux disease (GERD) between 2019 and 2022. Patients with previous renal replacement therapy (RRT) were excluded. The primary outcome was the first initiation of RRT. Propensity score (PS) matching (1:4) was applied, and hazard ratios (HRs) were estimated using Cox proportional hazards models. An intention-to-treat (ITT) analysis was also performed.
Results: A total of 34,077 patients were included, and 4107 P-CAB and 16,428 PPI users remained after matching. Over 60% in both groups were aged ≥ 65 years, and males were slightly more prevalent. P-CAB use was significantly associated with a lower risk of composite RRT initiation than PPI use (HR: 0.63, 95% confidence interval [CI]: 0.45-0.88). Although HRs for individual RRT events favored P-CABs, statistical significance was not reached. The ITT analysis showed consistent results (HR: 0.90, 95% CI: 0.82-0.99).
Conclusion: In this study, P-CABs were…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 34,077 participants or records.
Read the paper
Related studies
- Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study
- Treatment and prognostic factors for long-term outcome in patients with anti-N-Methyl-D-Aspartate (NMDA) receptor encephalitis: a cohort study
- Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study
- Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study
- Ethnic and socioeconomic differences in SARS-CoV-2 infection: prospective cohort study using UK Biobank
- Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational 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.