Journal of Clinical and Diagnostic Research. 2018 Oct, Vol-12(10): FC05-FC09 5 5 DOI: 10.7860/JCDR/2018/36570.12122 Original Article Pharmacology Section Assessment of Renal Parameters in Patients on Proton Pump Inhibitors and Risk of Chronic Kidney Disease INTRODUCTION Proton pump inhibitors are one of the commonly prescribed drugs for peptic ulcer. Commonly prescribed PPIs are omeprazole, rabeprazole, pantoprazole and lansoprazole. PPIs are prescribed for both the approved and off label conditions. US FDA approved PPIs are indicated in peptic ulcer, gastritis, NSAIDs induced peptic ulcer, bleeding peptic ulcer, Gastroesophageal Reflux Disease (GERD) and Zollinger Ellison syndrome [1]. Increase in usage of PPI is due to their availability as Over the Counter Drugs (OTC) by physician’s prescriptions. It has been reported that between 25% to 70% of prescriptions do not have proper indication [2]. These are found to be one of the over utilised drugs due to their effectiveness in suppressing the symptoms [3]. According to National Health and Nutrition Examination Survey results, 7.8% of US adults had used prescription PPIs in the previous 30 days which was less than real prevalence as these drugs were available as OTC drugs [4]. These preparations are used very irregularly by the patients even after the completion of prescribed duration. The adverse effects of PPIs are megaloblastic anaemia, atrophy of gastric mucosa, hyper-gastrinaemia, osteoporosis, hypomagnesemia and infections such as community acquired pneumonia [5] and Clostridium difficile [6] infections. According to WHO, kidney disease is responsible for nearly 850,000 deaths every year, of which CKD is the 12 th leading cause of death and 17 th leading cause of disability [7]. The annual incidence of CKD in India is approximately 150-200 per million populations (pmp) [8]. PPIs are one of the common causes of Acute Interstitial Nephritis (AIN) [9]. Coca SG et al., conducted a systematic review and meta-analysis on the development of CKD after acute kidney injury and reported that AKI is a significant risk factor for the development, progression of CKD as well as end stage renal disease [10]. In a review on PPI use and kidney disease, it has been stated that many isolated case reports and case series on development of AKI due to PPI use and has also been described that PPI-induced AIN might cause irreversible inflammation in the renal interstitium, which may have negative long-standing effects on the kidney [11]. A cohort of 10,482 who were self-reported PPI users with eGFR at least 60 mL/ minute/1.73 m 2 in Atherosclerosis Risk in Communities (ARIC) study were followed and findings were replicated in patients receiving care in Geisinger Health System was analysed by Lazarus B et al., and the study results revealed that PPIs use was associated with 20-50% higher risk of incident CKD [12]. Arora P et al., conducted two independent retrospective case- control studies with prospective logistic regression analysis of data had shown that among those who developed CKD, 24.4% were found to be on PPIs [13]. A recent retrospective study had shown that 19 (10.86%) out of 175 patient who were on PPIs for at least seven consecutive days was found to have acute kidney injury. Pantoprazole was the most common drug involved (84.21%) and AKI common in the age group above 50 years [14]. From India, only a few case reports and retrospective analysis of kidney disease have been observed in relation to PPIs use. As there were no prospective studies linking the duration of PPIs use with kidney disease, present study was undertaken. The present study was aimed to assess the renal parameters- serum creatinine and BUN in patients on PPIs and to correlate these SHIVAGANESH CHELLAPPA 1 , MADHAVI EERIKE 2 , VENU GOPALA RAO KONDA 3 , RUCKMANI ARUNACHALAM 4 , DURGA KRISHNAN 5 Keywords: Blood urea nitrogen, Estimated GFR, Gastritis, Peptic ulcer, Serum creatinine ABSTRACT Introduction: Proton Pump Inhibitors (PPIs) are one of the commonly prescribed drugs for peptic ulcer. It has been reported that 25% to 70% of prescriptions do not have proper indication. Recently these drugs are linked with increased incidence of kidney disease. Aim: The present study was conducted to assess the renal parameters in patients on PPI and to correlate it with the duration of treatment and Chronic Kidney Disease (CKD). Materials and Methods: A prospective observational study was carried out among 30 control and 30 test participants. Subjects were enrolled according to inclusion and exclusion criteria. After getting written informed consent, demographic and medication details were recorded. Blood sample was collected for estimation of serum creatinine and Blood Urea Nitrogen (BUN). Estimated Glomerular Filtration Rate (eGFR) was calculated based on serum creatinine levels. Demographic data, medication details and eGFR were expressed as percentage and renal parameters analysed by ANOVA and unpaired t-test. A p<0.05 was considered significant. Results: About 66.67% in control group and 86.67% in test group were males. Only 60% of them were using pantoprazole regularly for peptic ulcer. There was a significant increase (p<0.05) in serum creatinine and not in BUN in test group when compared to control. About 13% of participants had serum creatinine above 1.3 mg/dL. About 40% of test group subjects eGFR was less than <90 mL/minute/1.73 m 2 . There was no correlation between renal parameters and type and regularity of use of PPI. Conclusion: The use of PPI whether regular or irregular, irrespective of the type was associated with significant increase in serum creatinine and caused decrease in kidney function status. Study with large sample size is required for giving definitive conclusion.