Research Scholar Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal Manipal, India
Background: Literature is evident for the risk of kidney disease following the use of proton pump inhibitors (PPI) and meta-analyses considered to be the highest level of evidence among them.
Objectives: We aimed to perform an overview to summarize and critically appraise the existing meta-analyses on PPI use and kidney diseases to grade the certainty of evidence.
Methods: We followed the Preferred Reporting Items for Systematic Review (PRISMA) guidelines to establish the patients, exposure, control, and outcome (PECO) for reviewing published meta-analyses. Data sources such as PubMed/ MEDLINE, SCOPUS, Embase, and Cochrane Library from inception to November 2022 were accessed. The meta-analyses assessing the risk of kidney diseases following the use of PPI were included in this study. The outcomes such as risk of acute kidney injury (AKI), chronic kidney disease (CKD), and end-stage renal disease (ESRD) were considered. The AMSTAR-2 checklist was used to assess the quality of published meta-analyses. A narrative synthesis was performed to summarize the available evidence.
Results: A total of 8 meta-analyses were included out of 1304 non-duplicate records. The overview observed that PPI use was significantly associated with a higher risk of AKI (n=5 studies), CKD (n=6 studies), and ESRD (n=6 studies) compared to non-PPI users. Similarly, PPI use was significantly associated with a higher risk of AKI (n=2 studies), CKD (n=4 studies), and ESRD (n=3 studies) compared to the H2RA users. Heterogeneity was observed to be moderate to high in the included meta-analyses. The selection of the study participants and confounding factors majorly contributed to the risk of bias in the included meta-analyses. The quality of included meta-analysis was observed to be moderate to high.
Conclusions: The current overview confirms the significant association between the use of PPI and kidney diseases compared to the non-PPI and H2RA users. Hence, policy and decision-makers should bring the guidelines to control the inappropriate use of PPI.
