On 2016 Apr 13, NephJC - Nephrology Journal Club commented:

This trial was discussed on March 15th and 16th 2016 in the open online nephrology journal club, #NephJC, on twitter. Introductory comments are available at the NephJC website.<br> The discussion was quite dynamic, with more than 75 participants, including nephrologists, gastroenterologists, geriatricians, clinical pharmacists, fellows, residents and patients, and included one of the authors (F. Perry Wilson). The transcript of the entire tweetchat is available on the NephJC website.<br> Some of the highlights of the tweetchat were:

• The team of investigators should be commended for designing and conducting this trial, and the NIH for funding the investigators, specifically the NHLBI for funding the ARIC study.

• The research team leveraged an existing study (ARIC) to test the association between PPI use and kidney disease, and went on validate the findings in another cohort (Geisinger). Along with the detailed statistical analysis and the robustness across various subgroups, this data does suggest a link between PPI use and chronic kidney disease (the link with acute kidney injury has been made before, and was also found in this study) with a very concerning number needed to harm (~ 30 in the ARIC cohort and 59 with the Geisinger cohort).

• However, given the wide prevalence of PPI use and quite likely some residual confounding for unmeasured factors (such as frailty), as also the lack of a firm biological basis for chronic kidney damage, most participants felt further replication of these findings would be more convincing. Despite the relatively low number needed to harm, PPIs have a remarkably lower number needed to treat (eg NNT 4, compared to ranitidine for reflux esophagitis). Nevertheless, deprescribing PPIs, especially with a useful algorithm such as this, could be incorporated into practice.

Interested individuals can track and join in the conversation by following @NephJC on twitter, liking #NephJC on facebook, signing up for the mailing list, or visit the webpage at NephJC.com.

On 2016 Apr 13, NephJC - Nephrology Journal Club commented:

This trial was discussed on March 15th and 16th 2016 in the open online nephrology journal club, #NephJC, on twitter. Introductory comments are available at the NephJC website.<br> The discussion was quite dynamic, with more than 75 participants, including nephrologists, gastroenterologists, geriatricians, clinical pharmacists, fellows, residents and patients, and included one of the authors (F. Perry Wilson). The transcript of the entire tweetchat is available on the NephJC website.<br> Some of the highlights of the tweetchat were:

• The team of investigators should be commended for designing and conducting this trial, and the NIH for funding the investigators, specifically the NHLBI for funding the ARIC study.

• The research team leveraged an existing study (ARIC) to test the association between PPI use and kidney disease, and went on validate the findings in another cohort (Geisinger). Along with the detailed statistical analysis and the robustness across various subgroups, this data does suggest a link between PPI use and chronic kidney disease (the link with acute kidney injury has been made before, and was also found in this study) with a very concerning number needed to harm (~ 30 in the ARIC cohort and 59 with the Geisinger cohort).

• However, given the wide prevalence of PPI use and quite likely some residual confounding for unmeasured factors (such as frailty), as also the lack of a firm biological basis for chronic kidney damage, most participants felt further replication of these findings would be more convincing. Despite the relatively low number needed to harm, PPIs have a remarkably lower number needed to treat (eg NNT 4, compared to ranitidine for reflux esophagitis). Nevertheless, deprescribing PPIs, especially with a useful algorithm such as this, could be incorporated into practice.

Interested individuals can track and join in the conversation by following @NephJC on twitter, liking #NephJC on facebook, signing up for the mailing list, or visit the webpage at NephJC.com.