Impact of Proton Pump Inhibitors on Renal Function: A Prospective Observational Study

Abstract

Background: Proton pump inhibitors (PPIs) are widely prescribed for acid-related gastrointestinal disorders. Recent observational studies have raised concerns about potential associations between long-term PPI use and adverse renal outcomes, including acute kidney injury and chronic kidney disease. However, the mechanisms and temporal relationships remain poorly understood.

Objectives: To prospectively evaluate changes in renal function parameters in PPI users compared to non-users over a three-month period, specifically assessing serum creatinine, blood urea nitrogen (BUN), and spot protein-to-creatinine ratio (PCR).

Methods: This prospective observational study enrolled 120 participants (60 PPI users and 60 non-users) aged 18–60 years at a tertiary care hospital. Participants with pre-existing kidney disease, concurrent hypertension and diabetes mellitus, or use of nephrotoxic medications were excluded. Renal function parameters were measured at baseline and after three months. Statistical analyses included paired and unpaired t-tests and multiple linear regressions.

Results: At baseline, both groups had comparable renal function parameters. After three months, PPI users demonstrated significant increases in serum creatinine (0.80±0.24 to 1.42±0.31 mg/dL vs. 0.87±0.32 to 0.90±0.30 mg/dL in controls; p<0.0012), BUN (9.79±0.87 to 12.05±1.28 mg/dL vs. 9.73±0.90 to 9.77±0.90 mg/dL; p<0.0012), and spot PCR (0.18±0.07 to 3.80±0.83 vs. 0.15±0.03 to 0.17±0.09; p<0.0012). Multiple linear regression showed no significant associations between predictor variables and serum creatinine (R²=0.043).

Conclusions: This study demonstrates a significant association between PPI use and deterioration of renal function parameters, particularly manifested by increased proteinuria. These findings underscore the need for judicious prescribing practices and regular monitoring of renal function in patients receiving long-term PPI therapy.