March 23, 2020
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PPIs linked to risk for kidney stones in women

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Risk for kidney stones increased with use of proton pump inhibitors, according to data published in Clinical Gastroenterology and Hepatology.

“H2RA use also has an association with risk of kidney stones, so acid suppression might be an involved mechanism,” Michael Simonov, MD, from the department of Medicine at Yale University School of Medicine, and colleagues wrote. “The effect is small and should not change prescribing for most patients.”

Researchers conducted a retrospective study of 465,891 patients who used PPIs and collected data on demographics, laboratory results, comorbidities and medication use from the Women’s Veterans’ Cohort Study. The risk for PPI use and incident development of kidney stones was determined with time-varying Cox proportional hazards and propensity matching analyses. Investigators measured H2RA and levothyroxine served as a negative control exposure.

In the unadjusted analysis, PPI use correlated with kidney stones. PPI use was considered a time-varying variable (HR = 1.74; 95% CI, 1.67–1.82), and persisted in the adjusted analysis (HR, 1.46; CI, 1.38–1.55). In a propensity score-matched subset of PPI users vs. nonusers, the correlation between PPI use and kidney stones was maintained (adjusted HR = 1.25; CI 1.19–1.33). An increased PPI dosage correlated with the increased risk for kidney stones (HR = 1.11; CI, 1.09–1.14 for each increase in 30 defined daily doses over a 3-month period). Additionally, H2RAs also correlated with an increased risk (adjusted HR = 1.47; CI 1.31–1.64).

According to researchers, in the adjusted analysis, no correlation was found between levothyroxine use and kidney stones.

“Though the hazard ratios for PPIs and H2RAs are similar, the populations used in the two analyses are very distinct and therefore it is difficult to directly compare hazards between the populations,” the researchers wrote. “Levothyroxine, our negative control exposure, carried no association in adjusted or propensity-matched analysis, suggesting that important confounders were captured in this study.” – by Monica Jaramillo

Disclosures: Simonov reports no relevant financial disclosures. Please the study for a list of all other authors’ relevant financial disclosures.