LAUSR

Proton pump inhibitors (PPIs) are among the most widely prescribed medications worldwide. However, these products are often overprescribed and used for unwarranted long durations, contributing to substantial expense, polypharmacy, and potential adverse reactions. Evidence from observational studies suggest that PPIs are associated with interstitial nephritis, acute kidney injury, and chronic kidney disease (CKD). For example, Antoniou and colleagues found that hospital admissions for acute kidney injury occurred with more than twice the frequency in PPI users than in non-users (HR = 2.52; 95% CI: 2.27, 2.79). Lazarus and colleagues found a hazard ratio of 1.50 (1.14, 1.96) for CKD in PPI users compared to non-users. These associations have been replicated in numerous studies. In contrast, a randomized controlled trial (RCT) by Moayyedi and colleagues concluded that the PPI “pantoprazole is not association with any adverse event [including chronic kidney disease] when used for 3 years, with the possible exception of an increased risk of enteric infections.” This reassurance was greeted with welcome relief. While it is convenient to assume that a relationship established by an experiment trumps those of observational studies, this may be “an oversimplification of the actual facts.” RCTs, like any type of study, can be designed in ways that have strengths and limitations. Because of the importance of the RCT in question, I believe it warrants a further look.