Work

Gut Guardianship: Recommendations for Rational Use of Proton Pump Inhibitors in Chronic Kidney Disease

Year: 2025

Type: article

Abstract: The widespread use of proton pump inhibitors (PPIs) has raised safety concerns, especially among patients with chronic kidney disease (CKD), where long-term use has been linked with acute interstitial nephritis (AIN), hypomagnesaemia, and potential progression to endstage kidney disease (ESKD). Recent observational studies and meta-analyses have yielded mixed evidence, calling for a nuanced and individualized approach to acid suppression in CKD. The concept of gut guardianship emphasizes cautious, indication-based prescribing, dose minimization, and structured deprescribing to preserve gut-renal health. This article reviews the current evidence and proposes a clinical toolkit for rational PPI use in CKD, based on risk stratification, guideline-based indications, and ongoing monitoring.

Source: Journal of the Pakistan Medical Association

DOI: 10.47391/jpma.25-94

Authors: Sourabh Sharma, Pawan Rawal, Sanjay Kalra

Institutions: Vardhman Mahavir Medical College & Safdarjung Hospital, Medanta The Medicity, Chandigarh University, Bharti Hospital

Language: English

Topic: Pharmaceutical Practices and Patient Outcomes

Subfield: Geriatrics and Gerontology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $650