Cohort studycited by the Tayebat archiveabstract only checked A-PPI-02 standard review
PPIs and kidney decline without acute kidney injury
Long-term kidney outcomes among users of proton pump inhibitors without intervening acute kidney injury.
Overview
Xie Y et al.. Kidney Int 2017 · PMID 28237709 · DOI 10.1016/j.kint.2016.12.021
Compared with H2-blocker users, PPI users had 19–30% higher rates of kidney decline.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Kidney outcomes without prior AKI.
- How was the study done?
Veterans cohort, 5 years.
- How many people, animals or samples were studied?
144,032 new users.
- What was actually found?
Modestly higher risk of CKD outcomes with PPIs.
- How large was the observed effect?
HR 1.19–1.30.
- What do the results mean in everyday life?
Possible small kidney risk.
- What are the study's limitations?
Observational; veterans.
- What does it say about Elawady's specific claim?
Partly supports.
- Do the results apply to Germany and Europe?
Association transferable.
- What can explicitly not be concluded from this study?
Causation.
Scientific in-depth review
1. Full reference
- Authors
- Xie Y, Bowe B, Li T, Xian H, Yan Y, Al-Aly Z
- Journal
- Kidney Int
- Year
- 2017
- Identifier
- PMID 28237709 DOI 10.1016/j.kint.2016.12.021
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
Is PPI use associated with chronic renal outcomes without intervening AKI?
3. Study design and population
- Study design
- Cohort study – Retrospective cohort, US Veterans Affairs databases, new users, censoring at AKI
- Population
Incident users of acid suppression
- Country
USA
- Period
5-year follow-up
- Sample size
144,032 (125,596 PPI; 18,436 H2RA)
- Inclusion and exclusion criteria
see abstract
4. Methods and endpoints
- Exposure / intervention
Incident PPI use
- Comparator
Incident H2RA use
- Endpoints
eGFR <60, incident CKD, eGFR decline >30%, ESRD or eGFR decline >50%
- Statistical methods
Survival models censored at AKI
5. Actual results
- Results
vs H2RA: eGFR <60 HR 1.19 (1.15–1.24); incident CKD 1.26 (1.20–1.33); eGFR decline >30% 1.22 (1.16–1.28); ESRD/>50% decline 1.30 (1.15–1.48); proportion mediated by AKI 44.7–46.72% across the four outcomes.
- Absolute risks
not reported in abstract
- Authors' conclusion
PPI use is associated with increased risk of chronic renal outcomes in the absence of intervening AKI.
6. Strengths
- Large new-user active-comparator design
- Several renal outcomes
7. Weaknesses
- Mostly older male veterans
- Residual confounding
- Administrative data
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Confounding by indication; channeling of sicker patients to PPIs possible.
9. Assessment of the statistical interpretation
Modest relative risks from observational data; see bias notes.
10. Relevance to the specific claim
C-PPI-01 (CKD).
11. Independent contrary findings
COMPASS (I-PPI-01); Brown 2021 (I-PPI-02) on residual confounding in similar designs.
12. Transferability to Germany and Europe
High: European (Swedish, UK, Dutch, German) data show similar associations; PPIs are widely used in Germany.
13. Overall methodological judgement
Consistent observational association of modest size.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | essentially correct but incomplete |
14. Open questions
15. Linked fact checks
Use by the Tayebat archive
Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.
- What the archive says about the study
Listed in the archive bibliography of the acid-blockers rule without its own interpretation; used implicitly to support the rule summary ('long-term suppression turns against the body: CKD, bacterial overgrowth, C. difficile, pneumonia, B12 and magnesium deficiency, hip fractures, microbiome change, excess mortality').
- A. What was actually studied?
Is PPI use associated with chronic renal outcomes without intervening AKI?
- B. What did the authors find?
vs H2RA: eGFR <60 HR 1.19 (1.15–1.24); incident CKD 1.26 (1.20–1.33); eGFR decline >30% 1.22 (1.16–1.28); ESRD/>50% decline 1.30 (1.15–1.48); proportion mediated by AKI 44.7–46.72% across the four outcomes.
- C. What conclusions do the authors themselves draw?
PPI use is associated with increased risk of chronic renal outcomes in the absence of intervening AKI.
- D. What does the archive derive from it?
Supports the CKD part of the summary.
- E. Is this derivation scientifically justified?
As an association yes; causality not established.
- Adequacy of the interpretation (by the archive)
- essentially correct but incomplete