Comparative renal safety: potassium-competitive acid blockers vs proton pump inhibitors
Abstract
Background: Proton pump inhibitors (PPIs) are associated with an increased risk of acute kidney injury and incident chronic kidney disease. Potassium-competitive acid blockers (P-CABs) have emerged as potent alternatives to PPIs, but their renal impact remains unclear.
Methods: This study compared renal outcomes between P-CAB and PPI in patients receiving either PPIs or P-CABs at a tertiary referral hospital in Korea between 2019 and 2023. Renal outcomes were defined as creatinine doubling and a decline in estimated glomerular filtration rate (eGFR) ≥50%, termed as "eGFR decline." We used Cox proportional hazard analyses to adjust for multiple covariates.
Results: The study included 1820 and 5121 patients in the P-CAB and PPI groups, respectively. The P-CAB group had lower incidences of creatinine doubling (13.4 vs 36.5, log-rank P P P P P P = .005) for eGFR decline.
Conclusions: P-CABs showed a lower risk of renal function decline compared with PPIs, suggesting that P-CABs may be a safer alternative for long-term acid suppression. Further studies incorporating other P-CABs and PPIs are needed to confirm these findings.
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