# H2-antagonisten verlagen nierrisico meer dan protonpompremmers bij NSAID-gebruikers

*geplaatst 2026-09-11 · Hartfalen · Journal of nephrology · doi 10.1093/joneph/aajag176 · https://hartvaat.nl/2026/09/03/h2-antagonisten-verlagen-nierrisico-meer-dan-protonpompremmers-bij-nsaid-gebruik/*

In een retrospectieve cohortstudie onder 141.000 CKD-patiënten die NSAID's gebruikten, bleek het gebruik van protonpompremmers (PPI's) gepaard te gaan met een hoger risico op nierfunctieverslechtering vergeleken met H2-antagonisten (aHR 1,38). SGLT2-remmers daarentegen toonden een beschermend effect (aHR 0,49), met name bij vrouwen, patiënten ≥71 jaar en bij CKD-stadium 3. Deze bevindingen ondersteunen een voorzichtige houding bij het voorschrijven van PPI's in de nefrologische en cardiorenale praktijk, waarbij H2-antagonisten een veilig alternatief kunnen zijn.

## English: Chronic kidney disease progression with proton pump inhibitors versus H2 receptor antagonists in NSAID users.

A retrospective cohort study of 141,000 CKD patients using traditional NSAIDs found that proton pump inhibitors (PPIs) were associated with a 38% higher risk of CKD progression compared to H2-receptor antagonists (aHR 1.38). Conversely, SGLT2 inhibitors demonstrated a protective effect (aHR 0.49), with the PPI-related risk most pronounced in women, patients aged ≥71, and those with stage 3 CKD. These findings suggest H2 antagonists may be a safer acid-suppressive alternative in cardiorenal and primary care settings where PPIs are not strictly indicated.

## Abstract (original, from the publication)

BACKGROUND: Clinical evidence comparing the renal impact of proton pump inhibitors (PPIs) and Histamine-2 receptor antagonists (H2RAs) in patients with chronic kidney disease (CKD) receiving traditional non-steroidal anti-inflammatory drugs (tNSAIDs) is lacking. We evaluated CKD progression risk associated with PPIs versus H2RAs within a tNSAID-treated cohort to inform clinical prescribing. METHODS: This retrospective cohort study used South Korean nationwide claims data (2018-2023). Stabilized inverse probability of treatment weighting (SIPTW) balanced the cohorts. Restricted cubic spline Cox regression addressed non-linear associations between CKD progression and cumulative exposure to tNSAIDs and acid suppressants (PPIs or H2RAs). Sensitivity analyses addressing unspecified CKD stages confirmed the robustness of the primary findings. RESULTS: Among 141 093 tNSAID initiators with CKD prescribed PPIs (n = 5315) or H2RAs (n = 7112), PPIs were associated with higher CKD progression risk than H2RAs (adjusted hazard ratio [aHR] 1.38, 95% CI 1.10-1.74). Baseline comorbidities-hypertension (aHR 2.03, 95% CI 1.37-2.99]), diabetes (1.69 [1.29-2.21]), and a history of kidney disease (1.43 [1.13-1.81])-and prior diuretic use (2.00 [1.56-2.58]) were associated with increased risk of CKD progression. In contrast, dapagliflozin or empagliflozin use was protective (0.49 [0.27-0.89]). The risk of CKD progression for PPIs relative to H2RAs was most pronounced in females, those with CKD stage 3, patients aged ≥71 years, and those with 1-15 days of treatment (all P < .05). CONCLUSION: Our findings suggest that H2RAs may be associated with a lower risk of CKD progression than PPIs in tNSAID users with CKD, potentially offering a safer alternative when PPI therapy is not indispensable.

Auteurs: Susin Park, Pusoon Chun

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Bron: Journal of nephrology, https://doi.org/10.1093/joneph/aajag176. Bijgewerkt 2026-09-04T01:16:11Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.