The following is a summary of “Effects of Pantoprazole on Kidney Outcomes Post Hoc Observational Analysis from the COMPASS Trial,” published in the April 2024 issue of Nephrology by Pyne et al.
Proton pump inhibitor (PPI) use has been linked with worsening kidney function over time. However, no clear cause and effect has been defined yet.
Researchers conducted a prospective study analyzing the effect of pantoprazole, one of the PPIs, on kidney function.
They used data from the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial, where 17,598 participants were randomized to take either pantoprazole (8,791) or placebo (8,807). The rate of change in the estimated glomerular filtration rate (eGFR) was noted as the primary outcome. Secondary outcomes included incident chronic kidney disease (CKD) (defined by eGFR <60 ml/min/1.73m2 as well as acute kidney injury (AKI), acute nephritis, and nephrotic syndrome.
The results showed eGFR change in 8,991 out of 17,598 participants with a mean age of 67 [SD 8] years, 22% female, with mean baseline eGFR of 75 ml/min/1.73m2 were randomized to pantoprazole/placebo. The mean duration between randomization and eGFR measurement was 3.3 [SD 0.8] years. Placebo declined kidney functioning by -1.41 (SD 4.45) ml/min/1.73m2 per year, while pantoprazole declined kidney functioning by -1.64 (SD 4.47) ml/min/1.73 m2 per year. Even after adjusting for other factors, pantoprazole had a more significant effect on kidney function (0.27 ml/min/1.73 m2 per year (95% CI; 0.11-0.43). The odds ratio of getting CKD was similar in both the groups (1.11, 95% 0.98-1.25) and on AKI was 0.89 (95% CI 0.65-1.21). Also, there were 5 cases of nephrotic syndrome and 1 event of acute nephritis.
Investigators concluded that pantoprazole had a greater rate of eGFR decline than placebo; however, the clinical importance of this is uncertain.
Source: journals.lww.com/jasn/abstract/9900/the_effects_of_pantoprazole_on_kidney_outcomes.291.aspx
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