Pantoprazole Yields Greater Rate of eGFR Decline Than Placebo

Lonnie Pyne

New data shows how pantoprazole could effect the rate of eGFR decline.

A team, led by Lonnie Pyne, Population Health Research Institute, assessed the effect of pantoprazole on long-term kidney function.

Proton Pump Inhibitors and Kidney Function

It is currently unknown how proton pump inhibitors (PPIs) effect kidney function.

In the placebo-controlled, partial factorial randomized controlled trial Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) study, the investigators randomized 17,598 patients with chronic atherosclerotic vascular disease that were not treated with PPIs to either pantoprazole 40 mg daily or placebo, in addition to aspirin, aspirin and rivaroxaban, or rivaroxaban alone.

The data was presented as a late-breaking abstract during the 2022 American Society of Nephrology (ASN) Annual Meeting in Orlando.

Outcomes

The investigators sought primary outcomes of the mean rate of change of eGFR in patients with eGFR recorded at baseline and at entry to the long-term, open label extension.

They also sought secondary outcomes of the risk of chronic kidney disease, defined as a eGFR <60 ml/min/1.73 m²), acute kidney injury (AKI), acute nephritis, and nephrotic syndrome.

Overall, there were 8991 patients with eGFR recorded at baseline and at the beginning of the long-term, open label extension. This group was included in the rate of eGFR change population.

During a mean follow-up of 3.4 years, there was a mean rate of eGFR change of -1.37 ml/min/1.73 m² per year in the placebo group.

For the pantoprazole group, the mean rate of eGFR change was -1.59 ml/min/1.73 m² per year.

The treatment group also had a 0.26 ml/min/1.73 m² per year greater decline in mean eGFR compared to placebo (95% CI, 0.10-0.41; P = 0.002). The adjusted odds ratio for the effect of the drug on incidence CKD was 1.11 (95% CI, 0.98-1.25; P = 0.09). The aOR for AKI was 0.89 (95% CI, 0.65-1.21; P = 0.441).

“Pantoprazole resulted in a greater rate of eGFR decline as compared to placebo. The clinical importance of this effect is uncertain,” the authors wrote.

The study, “Effects of Pantoprazole on Kidney Outcomes: Post Hoc Analyses From the COMPASS Randomized Controlled Trial,” was published online by ASN.