This association was also noted in a second large cohort of 248 751 patients using PPIs prescribed in the Geisinger Health System, who were followed for a median of 6 years. In this cohort the researchers found 1921 incident chronic kidney disease events among 16,900 users (20.1 per 1000 person years) and 28,226 events among 231,851 non-users (18.3 per 1000 years); adjusted hazard ratio 1.24 (1.20 to 1.28)).
In a related editorial the authors discuss the effects of proton pump inhibitor use on other risk such as the risk of fractures, hypomagnesaemia, infections (Clostridium difficile infection or pneumonia) and cardiovascular events.
The authors conclude that “caution in prescribing PPIs should be used in patients at high risk for any of these conditions. Given the association with kidney disease and low magnesium levels, serum creatinine and magnesium levels should probably be monitored in patients using PPIs, especially those using high doses.
Additionally, it is recommended that patients and clinicians discuss the potential benefits and risks of PPI treatment, as well as potential alternative regimens such as histamine H2 receptor antagonists or lifestyle changes, before PPIs are prescribed. In patients with symptomatic gastrointestinal reflux, ulcer disease, and severe dyspepsia, the benefits of PPI use likely outweigh its potential harms. However, for less serious symptoms and for prevention of bleeding in low-risk patients, potential harms may outweigh the benefits. A large number of patients are taking PPIs for no clear reason—often remote symptoms of dyspepsia or “heartburn” that have since resolved. In these patients, PPIs should be stopped to determine if symptomatic treatment is needed.”