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Comment & Response |

Adverse Effects of Proton Pump Inhibitors in Chronic Kidney Disease—Reply

Benjamin Lazarus, MBBS1,2; Josef Coresh, MD, PhD1,3; Morgan E. Grams, MD, PhD1,3
[+] Author Affiliations
1Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
2Division of Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
3Department of Medicine, Johns Hopkins University, Baltimore, Maryland
JAMA Intern Med. 2016;176(6):869-870. doi:10.1001/jamainternmed.2016.1863.
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In Reply We share the concern expressed by Dr Lozano, Iannuzzella et al, Zhao et al, and Drs Ness-Jensen and Fossmark that observational studies may suffer from residual confounding. In the original study,1 to ensure that the observed associations were robust, we performed multiple sensitivity analyses and replicated results in a separate cohort. These analyses included adjustment for many possible confounders, including concomitant medication use, hypertension, body mass index, and diabetes mellitus. We also tested associations using an active comparator group (patients using H2 antagonists), a new-user design, and propensity-score matching. In the latter analysis, matched cohorts were well balanced (Table 1, as requested by Zhao et al), and the study design obviates the concern about multicollinearity that was raised by Drs Ness-Jensen and Fossmark. All sensitivity analyses were consistent and showed an association between proton pump inhibitor (PPI) use and incident chronic kidney disease (CKD).

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June 1, 2016
Maria Fusaro, MD, PhD; Sandro Giannini, MD; Maurizio Gallieni, MD
1National Research Council (CNR)–Institute of Clinical Physiology (IFC), Pisa, Italy2Clinica Medica 1, Department of Medicine, University of Padova, Padua, Italy
2Clinica Medica 1, Department of Medicine, University of Padova, Padua, Italy
3Nephrology and Dialysis Unit, ASST Ospedale Santi Paolo e Carlo, Department of Biomedical and Clinical Sciences “Luigi Sacco,” University of Milano, Milan, Italy
JAMA Intern Med. 2016;176(6):866. doi:10.1001/jamainternmed.2016.1845.
June 1, 2016
Roberto Lozano, PhD
1Department of Pharmacy, Hospital Real Ntra Sra de Gracia, Zaragoza, Spain
JAMA Intern Med. 2016;176(6):866-867. doi:10.1001/jamainternmed.2016.1848.
June 1, 2016
Pan Zhao, MD; Zhenman Wei, PhD; Jin Han, PhD
1Clinical Trial Center, Liver Failure Therapy and Research Center, Beijing 302 Hospital (PLA 302 Hospital), Beijing, China2Division of Pharmacology, Beijing 302 Hospital (PLA 302 Hospital), Beijing, China
2Division of Pharmacology, Beijing 302 Hospital (PLA 302 Hospital), Beijing, China
2Division of Pharmacology, Beijing 302 Hospital (PLA 302 Hospital), Beijing, China3Adverse Drug Reaction Monitoring Center, Beijing 302 Hospital (PLA 302 Hospital), Beijing, China
JAMA Intern Med. 2016;176(6):867. doi:10.1001/jamainternmed.2016.1851.
June 1, 2016
Ruben Poesen, MD; Björn Meijers, MD, PhD; Pieter Evenepoel, MD, PhD
1Department of Microbiology and Immunology, Division of Nephrology, University Hospitals Leuven, B-3000 Leuven, Belgium
JAMA Intern Med. 2016;176(6):867-868. doi:10.1001/jamainternmed.2016.1854.
June 1, 2016
Eivind Ness-Jensen, MD, PhD; Reidar Fossmark, MD, PhD
1Department of Gastroenterology and Hepatology, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway2Norwegian University of Science and Technology, Trondheim, Norway
JAMA Intern Med. 2016;176(6):868. doi:10.1001/jamainternmed.2016.1857.
June 1, 2016
Francesco Iannuzzella, MD; Mattia Corradini, PhD; Sonia Pasquali, MD
1Nephrology and Dialysis Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
JAMA Intern Med. 2016;176(6):868-869. doi:10.1001/jamainternmed.2016.1860.
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