Cohort studycited by the Tayebat archiveabstract only checked A-PPI-03 standard review
PPIs and CKD progression in Stockholm
Association Between Proton Pump Inhibitor Use and Risk of Progression of Chronic Kidney Disease.
Overview
Klatte DCF et al.. Gastroenterology 2017 · PMID 28583827 · DOI 10.1053/j.gastro.2017.05.046
PPI starters had about 26% higher risk of kidney function decline than H2-blocker starters.
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?
CKD progression with PPIs.
- How was the study done?
Swedish regional database.
- How many people, animals or samples were studied?
About 115,000 new users.
- What was actually found?
Modestly higher progression risk.
- How large was the observed effect?
HR 1.26.
- What do the results mean in everyday life?
Possible small risk.
- What are the study's limitations?
Residual confounding acknowledged.
- What does it say about Elawady's specific claim?
Partly supports.
- Do the results apply to Germany and Europe?
Directly European.
- What can explicitly not be concluded from this study?
Causation.
Scientific in-depth review
1. Full reference
- Authors
- Klatte DCF, Gasparini A, Xu H, de Deco P, Trevisan M, Johansson ALV, Wettermark B, Ärnlöv J, Janmaat CJ, Lindholm B, Dekker FW, Coresh J, Grams ME, Carrero JJ
- Journal
- Gastroenterology
- Year
- 2017
- Identifier
- PMID 28583827 DOI 10.1053/j.gastro.2017.05.046
- 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 CKD progression?
3. Study design and population
- Study design
- Cohort study – Retrospective new-user cohort, Stockholm creatinine measurements database
- Population
New users of PPIs and H2 blockers in Stockholm
- Country
Sweden
- Period
2007–2010; median 2.7 years
- Sample size
105,305 PPI; 9,578 H2B
- Inclusion and exclusion criteria
see abstract
4. Methods and endpoints
- Exposure / intervention
New PPI use; cumulative exposure
- Comparator
New H2-blocker use
- Endpoints
Doubling of creatinine or eGFR decline ≥30%; ESRD; AKI
- Statistical methods
Adjusted Cox models; cumulative exposure
5. Actual results
- Results
Doubling of creatinine HR 1.26 (1.05–1.51); eGFR decline ≥30% HR 1.26 (1.16–1.36); ESRD HR 2.40 (0.76–7.58, n.s.); AKI HR 1.30 (1.00–1.69); graded association with cumulative PPI exposure, not with H2B.
- Absolute risks
not reported in abstract
- Authors' conclusion
Initiation and cumulative PPI exposure are associated with CKD progression; association modest and cannot exclude residual confounding.
6. Strengths
- Complete pharmacy dispensing data
- Laboratory-based outcomes
- European setting
7. Weaknesses
- Short follow-up
- Authors acknowledge residual confounding
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
Authors explicitly cannot exclude residual confounding.
9. Assessment of the statistical interpretation
Modest relative risks from observational data; see bias notes.
10. Relevance to the specific claim
11. Independent contrary findings
COMPASS (I-PPI-01).
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
Good-quality European cohort; modest association.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| 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 CKD progression?
- B. What did the authors find?
Doubling of creatinine HR 1.26 (1.05–1.51); eGFR decline ≥30% HR 1.26 (1.16–1.36); ESRD HR 2.40 (0.76–7.58, n.s.); AKI HR 1.30 (1.00–1.69); graded association with cumulative PPI exposure, not with H2B.
- C. What conclusions do the authors themselves draw?
Initiation and cumulative PPI exposure are associated with CKD progression; association modest and cannot exclude residual confounding.
- D. What does the archive derive from it?
Supports the CKD claim.
- E. Is this derivation scientifically justified?
As association; authors themselves stress modest size and residual confounding.
- Adequacy of the interpretation (by the archive)
- essentially correct but incomplete