SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Pauline JOUET
Coup de coeur :
 
 
Gastroenterology
  2017/09  
 
  2017 Sep;153(3):702-710.  
  doi: 10.1053/j.gastro.2017.05.046  
 
  Association Between Proton Pump Inhibitor Use and Risk of Progression of Chronic Kidney Disease.  
 
  Klatte DCF, Gasparini A, Xu H, de Deco P, Trevisan M, Johansson ALV, Wettermark B, Ärnlöv J, Janmaat CJ, Lindholm B, Dekker FW, Coresh J, Grams ME, Carrero JJ  
  https://www.ncbi.nlm.nih.gov/pubmed/28583827  
 
 

Abstract

BACKGROUND & AIMS:

Proton pump inhibitors (PPI) have been associated with acute kidney injury and recent studies suggest that they may be associated with the risk of chronic kidney disease (CKD).

METHODS:

We performed a retrospective analysis using the Stockholm creatinine measurements database, which contains information on diagnoses, dispensation claims, and laboratory test results for all citizens in the Stockholm region from 2007 through 2010. We identified new users of PPIs (n = 105,305) and new users of H2 blockers (H2B; n = 9578); data on renal outcomes were collected for a median 2.7 years. The primary outcome was progression CKD, defined as doubling of creatinine or decrease in estimated glomerular filtration rate of 30% or more. Secondary outcomes were end-stage renal disease and acute kidney injury. Complete collection of repeated PPI and H2B dispensations at pharmacies in Sweden allowed modeling the time-dependent risk associated with cumulative PPI exposure.

RESULTS:

Users of PPIs, compared with users of H2Bs, had an increased risk for doubled levels of creatinine (1985 events; adjusted hazard ratio [HR], 1.26; 95% CI, 1.05-1.51) and decrease in estimated glomerular filtration rate of 30% or more (11,045 events; 1.26; 95% CI, 1.16-1.36). PPI use also associated with development of end-stage renal disease (HR, 2.40; 95% CI, 0.76-7.58) and acute kidney injury (HR, 1.30; 95% CI, 1.00-1.69). There was a graded association between cumulative exposure to PPIs and risk of CKD progression. This was not the case for cumulative H2B use.

CONCLUSIONS:

Initiation of PPI therapy and cumulative PPI exposure is associate with increased risk of CKD progression in a large, North European healthcare system. Although consistent, the association was modest in magnitude, and cannot exclude residual confounding.

 

 
Question posée
 
La prise d’IPP est-elle associée à un risque augmenté d’insuffisance rénale ?
 
Question posée
 
Dans cette étude rétrospective suédoise, les patients débutant un traitement par IPP (n=105305 ) en comparaison avec ceux débutant un traitement par anti-H2 (n= 9578) avaient un risque significativement augmenté de doubler leur chiffre de créatininémie (HR 1,26 ; IC 95%, 1,05-1,51), d’avoir une diminution d’au moins 30% de leur débit de filtration glomérulaire calculé (HR 1,26 IC 95% : 1,16-1,36), et de développer une insuffisance rénale chronique ((HR 2,40 IC 95% : 0,76-7,58).
 
Commentaires

La mise en évidence dans cette étude d’une association entre prise d’IPP et toxicité rénale est en faveur d’un risque possible et faible s’il existe, sans pouvoir exclure des facteurs confondants. On peut continuer à prescrire des IPP au long cours si indiqués et à la dose thérapeutique minimale.

 
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