Sun Jing, Sun Hongjun, Cui Meiyu, Sun Zhijian, Li Wenyue, Wei Jianxin, Zhou Shuhua
Department of Nephrology, Dezhou People's Hospital, No. 1751, Xinhu Road, Dezhou, 253014, Shandong, People's Republic of China.
Department of Blood Transfusion, Dezhou People's Hospital, Dezhou, 253014, Shandong, People's Republic of China.
Int Urol Nephrol. 2018 Oct;50(10):1835-1843. doi: 10.1007/s11255-018-1908-8. Epub 2018 Jun 13.
We conducted a meta-analysis to explore the association between the use of different anti-ulcer agents and the risk of chronic kidney disease (CKD), end-stage renal disease (ESRD), and decline in glomerular filtration rate (GFR) in various study populations.
PubMed, Embase, and the Cochrane Library were searched for relevant entries up to July 1, 2017. The primary outcomes of the meta-analysis were risk ratios (RRs) of CKD, ESRD, and decline in GFR. We also investigated the heterogeneity of the meta-analysis by subgroup analysis and meta-regression analysis.
A total of 662,624 individuals were enrolled in five trials. Compared with non-PPI users, PPI users had a higher trend of CKD (RR = 1.16, 95% CI 1.07-1.25, P < 0.001), especially ESRD (RR = 1.81, 95% CI 1.59-2.06, P < 0.001). There was an elevated risk of adverse renal outcome among participants receiving PPI and not H2RA (CKD: RR = 1.28, 95% CI 1.24-1.33, P < 0.001; ESRD: RR = 1.39, 95% CI 1.17-1.64, P < 0.001; GFR: RR = 1.31, 95% CI 1.26-1.36, P < 0.001). However, H2RA users were not associated with CKD when compared with non-H2RA users (RR = 1.02, 95% CI 0.83-1.25, P = 0.855). In subgroup analysis, the average age of individuals and drug dosage had no influence on the risk of CKD, while duration of PPI exposure from 31 to 720 days is a potential factor in progression to ESRD (P < 0.001).
Chronic PPI use, but not H2RAs, is associated with deterioration in kidney function.
我们进行了一项荟萃分析，以探讨在不同研究人群中使用不同抗溃疡药物与慢性肾脏病（CKD）、终末期肾病（ESRD）以及肾小球滤过率（GFR）下降风险之间的关联。
检索了截至2017年7月1日的PubMed、Embase和Cochrane图书馆的相关条目。荟萃分析的主要结局是CKD、ESRD和GFR下降的风险比（RRs）。我们还通过亚组分析和荟萃回归分析研究了荟萃分析的异质性。
五项试验共纳入662,624名个体。与非质子泵抑制剂（PPI）使用者相比，PPI使用者患CKD的趋势更高（RR = 1.16，95% CI 1.07 - 1.25，P < 0.001），尤其是ESRD（RR = 1.81，95% CI 1.59 - 2.06，P < 0.001）。接受PPI而非H2受体拮抗剂（H2RA）的参与者不良肾脏结局风险升高（CKD：RR = 1.28，95% CI 1.24 - 1.33，P < 0.001；ESRD：RR = 1.39，95% CI 1.17 - 1.64，P < 0.001；GFR：RR = 1.31，95% CI 1.26 - 1.36，P < 0.001）。然而，与非H2RA使用者相比，H2RA使用者与CKD无关（RR = 1.02，95% CI 0.83 - 1.25，P = 0.855）。在亚组分析中，个体的平均年龄和药物剂量对CKD风险没有影响，而PPI暴露持续31至720天是进展为ESRD的一个潜在因素（P < 0.001）。
长期使用PPI而非H2RA与肾功能恶化有关。
