Qiu Tingting, Zhou Junwen, Zhang Chao
Department of Pharmacy, Peking University Third Hospital, Beijing, China.
School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.
J Gastroenterol Hepatol. 2018 Apr 12. doi: 10.1111/jgh.14157.
More concerns had been raised about the risk of kidney disease (KD) associated with acid-suppressive drugs. But whether they could directly increase such risk remained unclear. Meta-analysis was conducted to comprehensively investigate this relationship.
PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and three Chinese databases were searched until April 2017 for observational studies investigating the associations between acid-suppressive drugs and KD. Pooled log (odds ratios [ORs]) or log (hazard ratios [HRs]) with standard errors for KD risk were calculated using the generic inverse variance method and random-effect model.
Ten studies involving 128 020 KD patients were included. Proton pump inhibitor (PPI) therapy was associated with higher risks of acute interstitial nephritis (OR, 2.78; 95% confidence interval [CI], 1.25-6.17), acute kidney injury (AKI) (HR, 1.85; 95% CI, 1.33-2.59), chronic kidney disease (CKD) (HR, 1.47; 95% CI, 1.03-2.09), and end-stage renal disease (ESRD) (HR, 1.61; 95% CI, 1.26-2.04) than non-PPI therapy. Additionally, PPI significantly increased the risks of AKI (HR, 1.32; 95% CI, 1.16-1.51), CKD (HR, 1.28; 95% CI, 1.24-1.33), and ESRD (HR, 1.96; 95% CI, 1.21-3.17) compared with histamine 2 receptor antagonist (H RA). Relationship between H RA therapy and AKI (OR, 0.98; 95% CI, 0.90-1.07) or CKD (OR, 1.00; 95% CI, 0.89-1.11) was not found.
Proton pump inhibitor therapy significantly increased the risks of acute interstitial nephritis, AKI, CKD, and ESRD. Similar risks were not identified for H RA therapy. More clinical trials are needed to confirm our findings.
人们越来越关注抑酸药物与肾脏疾病（KD）风险之间的关联。但它们是否会直接增加这种风险仍不明确。进行了荟萃分析以全面研究这种关系。
检索了PubMed、EMBASE、Cochrane对照试验中心注册库以及三个中文数据库，直至2017年4月，以查找调查抑酸药物与KD之间关联的观察性研究。使用通用逆方差法和随机效应模型计算KD风险的合并对数（比值比[ORs]）或对数（风险比[HRs]）及标准误。
纳入了10项涉及128020例KD患者的研究。与非质子泵抑制剂（PPI）治疗相比，PPI治疗与急性间质性肾炎（OR，2.78；95%置信区间[CI]，1.25 - 6.17）、急性肾损伤（AKI）（HR，1.85；95% CI，1.33 - 2.59）、慢性肾脏病（CKD）（HR，1.47；95% CI，1.03 - 2.09）和终末期肾病（ESRD）（HR，1.61；95% CI，1.26 - 2.04）的更高风险相关。此外，与组胺2受体拮抗剂（H RA）相比，PPI显著增加了AKI（HR，1.32；95% CI，1.16 - 1.51）、CKD（HR，1.28；95% CI，1.24 - 1.33）和ESRD（HR，1.96；95% CI，1.21 - 3.17）的风险。未发现H RA治疗与AKI（OR，0.98；95% CI，0.90 - 1.07）或CKD（OR，1.00；95% CI，0.89 - 1.11）之间的关系。
质子泵抑制剂治疗显著增加了急性间质性肾炎、AKI、CKD和ESRD的风险。未发现H RA治疗有类似风险。需要更多的临床试验来证实我们的发现。
