Wijarnpreecha Karn, Thongprayoon Charat, Chesdachai Supavit, Panjawatanana Panadeekarn, Ungprasert Patompong, Cheungpasitporn Wisit
Department of Internal Medicine, Bassett Medical Center, One Atwell Road, Cooperstown, NY, 13326, USA.
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Dig Dis Sci. 2017 Oct;62(10):2821-2827. doi: 10.1007/s10620-017-4725-5. Epub 2017 Aug 23.
BACKGROUND/AIMS: The aim of this meta-analysis was to assess the risks of chronic kidney disease (CKD) and/or end-stage kidney disease (ESRD) in patients who are taking proton-pump inhibitors (PPIs) and/or H2 receptor antagonists (H2RAs).
Comprehensive literature review was conducted utilizing MEDLINE and EMBASE databases through April 2017 to identify all studies that investigated the risks of CKD or ESRD in patients taking PPIs/H2RAs versus those without PPIs/H2RAs. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this study is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017067252).
Five studies with 536,902 participants were patients were identified and included in the data analysis. When compared with non-PPIs users, the pooled risk ratio (RR) of CKD or ESRD in patients with PPI use was 1.33 (95% CI 1.18-1.51). Pre-specified subgroup analysis (stratified by CKD or ESRD status) demonstrated pooled RRs of 1.22 (95% CI 1.14-1.30) for association between PPI use and CKD and 1.88 (95% CI 1.71-2.06) for association between PPI use and ESRD, respectively. However, there was no association between the use of H2RAs and CKD with a pooled RR of 1.02 (95% CI 0.83-1.25). When compared with the use of H2RAs, the pooled RR of CKD in patients with PPI use was 1.29 (95% CI 1.22-1.36).
Our study demonstrates statistically significant 1.3-fold increased risks of CKD and ESRD in patients using PPIs, but not in patients using H2RAs.
背景/目的：本荟萃分析旨在评估服用质子泵抑制剂（PPI）和/或H2受体拮抗剂（H2RA）的患者发生慢性肾脏病（CKD）和/或终末期肾病（ESRD）的风险。
利用MEDLINE和EMBASE数据库进行全面的文献检索，检索截至2017年4月的所有研究，这些研究调查了服用PPI/H2RA的患者与未服用PPI/H2RA的患者发生CKD或ESRD的风险。采用DerSimonian和Laird的随机效应、通用逆方差方法计算合并风险比（RR）和95%置信区间（CI）。本研究方案已在PROSPERO（国际系统评价前瞻性注册库；编号CRD42017067252）注册。
确定了五项研究，共536,902名参与者，并纳入数据分析。与未使用PPI的患者相比，使用PPI的患者发生CKD或ESRD的合并风险比（RR）为1.33（95%CI 1.18 - 1.51）。预先设定的亚组分析（按CKD或ESRD状态分层）显示，使用PPI与CKD之间关联的合并RR为1.22（95%CI 1.14 - 1.30），使用PPI与ESRD之间关联的合并RR为1.88（95%CI 1.71 - 2.06）。然而，使用H2RA与CKD之间无关联，合并RR为1.02（95%CI 0.83 - 1.25）。与使用H2RA相比，使用PPI的患者发生CKD的合并RR为1.29（95%CI 1.22 - 1.36）。
我们的研究表明，使用PPI的患者发生CKD和ESRD的风险在统计学上显著增加了1.3倍，但使用H2RA的患者未出现这种情况。
