Huntsberry Ashley M, Linnebur Sunny A, Fixen Danielle R, Saba Laura M, Saseen Joseph J
Sr Care Pharm. 2019 May 1;34(5):325-333.
Proton-pump inhibitors (PPIs) have been associated with adverse renal outcomes in older adults; however, there are little data regarding the magnitude of the change in renal function in this population. The objective of this study was to quantify the change in kidney function associated with chronic PPI therapy at two years in older adults using estimated glomerular filtration rate (eGFR).
The study was a retrospective, pre/post, observational cohort.
The study included University of Colorado Health primary care patients 60 to 89 years of age who were newly initiated on a PPI between August 1, 2012, and March 1, 2015, and remained on therapy for at least two years. The primary outcome was the change in kidney function, measured by eGFR, two years after starting PPI therapy. Secondary outcomes included change in kidney function and incidence of reduction in eGFR to < 60 mL/min/1.73 m² two years post-index date between patients with and without diabetes mellitus.
Of 877 electronic health records reviewed, 100 patients met inclusion criteria. The mean change in eGFR was -6.15 mL/min/1.73 m² (standard error of the mean = 1.03) at two years compared with baseline
(95% confidence interval -8.20 to -4.10; < 0.0001). There were no differences in the secondary outcomes based on concomitant diabetes mellitus.
Chronic PPI use was associated with a significant reduction in eGFR in ambulatory older adults at two years, beyond that expected based on increased age alone. Prescribers should be aware of the potential adverse renal effects of chronic PPI use.
质子泵抑制剂（PPIs）与老年人不良肾脏结局相关；然而，关于该人群肾功能变化程度的数据很少。本研究的目的是使用估计肾小球滤过率（eGFR）量化老年人在两年慢性PPI治疗后肾功能的变化。
该研究是一项回顾性、前后对照的观察性队列研究。
该研究纳入了科罗拉多大学健康中心60至89岁的初级保健患者，这些患者于2012年8月1日至2015年3月1日开始新使用PPI，并持续治疗至少两年。主要结局是开始PPI治疗两年后通过eGFR测量的肾功能变化。次要结局包括肾功能变化以及索引日期后两年内糖尿病患者和非糖尿病患者eGFR降至<60 mL/min/1.73 m²的发生率。
在审查的877份电子健康记录中，100名患者符合纳入标准。与基线相比，两年时eGFR的平均变化为-6.15 mL/min/1.73 m²（平均标准误差=1.03）
（95%置信区间-8.20至-4.10；P<0.0001）。基于是否合并糖尿病，次要结局没有差异。
在非卧床老年人中，慢性使用PPI与两年时eGFR显著降低相关，这超出了仅基于年龄增长所预期的降低幅度。处方医生应意识到慢性使用PPI的潜在不良肾脏影响。
