质子泵抑制剂的使用对慢性肾脏病 G3a 至 G4 期患者肾功能病程的影响。

The Effect of Proton Pump Inhibitor Use on the Course of Kidney Function in Patients with Chronic Kidney Disease Stages G3a to G4.

机构信息

Tulane University School of Medicine, Deming Department of Medicine, Section of Nephrology, New Orleans, Louisiana; Southeast Louisiana Veterans Health Care System, Medicine Service, Section of Nephrology, New Orleans, Louisiana.

Tulane University School of Public Health Department of Global Health Management and Policy (GHMP) Tulane University School of Public Health and Tropical Medicine (TUSPHTM), New Orleans, Louisiana.

出版信息

Am J Med Sci. 2021 Nov;362(5):453-461. doi: 10.1016/j.amjms.2021.05.017. Epub 2021 May 24.

DOI:10.1016/j.amjms.2021.05.017

PMID:34033809

Abstract

BACKGROUND

Proton pump inhibitors (PPI) are widely used and implicated in the progression of chronic kidney disease (CKD). We evaluated the relation between chronic PPI use in veterans with CKD G3a to G4 and the rate of decline in renal function.

METHODS

We accessed the Veteran Affairs Informatics and Computing Infrastructure national database to evaluate the relation between chronic PPI use and rate of decline in renal function in veterans with CKD (eGFR <60 ml/min1.73 m2). We applied Propensity Score Matching to match the PPI group and the no-PPI control group on age, sex, race, and Charlson Comorbidity Index. The final sample included 1406 patients (age: 62.07±7.82, 62.02% Caucasian) in the PPI cohort with a median 4.7 years follow-up and 1425 patients (age: 65.45±6.58, 71.16% Caucasian) in the control cohort with a median 3.9 years follow-up. Kaplan-Meier curve and Cox regression were performed to analyze the associations of PPI use with dialysis, all-cause mortality, metabolic acidosis, and CKD progression.

RESULTS

The PPI group had a significantly increased risk of CKD progression, dialysis and all-cause mortality (aHR, 1.83; 95% CI, 1.53 to 2.19; aHR, 1.84; 95% CI, 1.26 to 2.67; and aHR, 1.34; 95% CI, 1.08 to 1.65, respectively). The PPI cohort also had a trend for development of metabolic acidosis (aHR, 1.34; 95% CI, 0.998 to 1.80), although the difference was not statistically significant.

CONCLUSIONS

The data suggest that chronic PPI use accelerates progression of kidney disease and is associated with increased mortality in CKD patients.

摘要

背景

质子泵抑制剂（PPI）被广泛应用，并与慢性肾脏病（CKD）的进展有关。我们评估了慢性 PPI 在 CKD G3a 至 G4 退伍军人中的使用与肾功能下降速度之间的关系。

方法

我们访问了退伍军人事务部信息学和计算基础设施国家数据库，以评估慢性 PPI 在 CKD（eGFR <60 ml/min1.73 m2）患者中的使用与肾功能下降速度之间的关系。我们应用倾向评分匹配来匹配 PPI 组和无 PPI 对照组的年龄、性别、种族和 Charlson 合并症指数。最终样本包括 1406 名（年龄：62.07±7.82，62.02%白种人）PPI 队列患者，中位随访 4.7 年，1425 名（年龄：65.45±6.58，71.16%白种人）对照组患者，中位随访 3.9 年。Kaplan-Meier 曲线和 Cox 回归用于分析 PPI 使用与透析、全因死亡率、代谢性酸中毒和 CKD 进展的关系。

结果

PPI 组 CKD 进展、透析和全因死亡率的风险显著增加（调整后的 HR，1.83；95%CI，1.53 至 2.19；调整后的 HR，1.84；95%CI，1.26 至 2.67；和调整后的 HR，1.34；95%CI，1.08 至 1.65）。PPI 队列也有发展代谢性酸中毒的趋势（调整后的 HR，1.34；95%CI，0.998 至 1.80），尽管差异无统计学意义。