2015年4月に、66歳以上でのPPI使用で、急性腎不全で入院する患者が2倍増えると報告された。

Antoniou T, Macdonald EM, Hollands S, Gomes T, Mamdani MM, Garg AX, Paterson JM, Juurlink DN.

Proton pump inhibitors and the risk of acute kidney injury in older patients: a population-based cohort study.

CMAJ Open. 2015 Apr 2;3(2):E166-71.

BACKGROUND:

Proton pump inhibitors (PPIs) cause interstitial nephritis and are an underappreciated cause of acute kidney injury. We examined the risk of acute kidney injury and acute interstitial nephritis in a large population of older patients receiving PPIs.

METHODS:

We conducted a population-based study involving Ontario residents aged 66 years and older who initiated PPItherapy between Apr. 1, 2002, and Nov. 30, 2011. We used propensity score matching to establish a highly comparable reference group of control patients. The primary outcome was hospital admission with acute kidney injury within 120 days, and a secondary analysis examined acute interstitial nephritis. We used Cox proportional hazards regression to adjust for differences between groups.

RESULTS:

We studied 290 592 individuals who commenced PPI therapy and an equal number of matched controls. The rates of acute kidney injury (13.49 v. 5.46 per 1000 person-years, respectively; hazard ratio [HR] 2.52, 95% CI 2.27 to 2.79) and acute interstitial nephritis (0.32 vs. 0.11 per 1000 person-years; HR 3.00, 95% CI 1.47 to 6.14) were higher among patients given PPIs than among controls.

INTERPRETATION:

In our study population of older adults, those who started PPI therapy had an increased risk of acute kidney injury and acute interstitial nephritis. These are potentially reversible conditions that may not be readily attributed to drug treatment. Clinicians should appreciate the risk of acute interstitial nephritis during treatment with PPIs, monitor patients appropriately and discourage the indiscriminate use of these drugs.

そして、2016年1月11日、PPIの使用により、慢性腎疾患が増加するとJAMAで報告された。

Lazarus B, Chen Y, Wilson FP, Sang Y, Chang AR, Coresh J, Grams ME.

Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease.

JAMA Intern Med. 2016 Jan 11:238-246.

Importance  Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide and have been linked to acute interstitial nephritis. Less is known about the association between PPI use and chronic kidney disease (CKD).

Objective  To quantify the association between PPI use and incident CKD in a population-based cohort.

Design, Setting, and Participants  In total, 10 482 participants in the Atherosclerosis Risk in Communities study with an estimated glomerular filtration rate of at least 60 mL/min/1.73 m² were followed from a baseline visit between February 1, 1996, and January 30, 1999, to December 31, 2011. The data was analyzed from May 2015 to October 2015. The findings were replicated in an administrative cohort of 248 751 patients with an estimated glomerular filtration rate of at least 60 mL/min/1.73 m² from the Geisinger Health System.

Exposures  Self-reported PPI use in the Atherosclerosis Risk in Communities study or an outpatient PPI prescription in the Geisinger Health System replication cohort. Histamine₂ (H₂) receptor antagonist use was considered a negative control and active comparator.

Main Outcomes and Measures  Incident CKD was defined using diagnostic codes at hospital discharge or death in the Atherosclerosis Risk in Communities Study, and by a sustained outpatient estimated glomerular filtration rate of less than 60 mL/min/1.73 m² in the Geisinger Health System replication cohort.

Results  Among 10 482 participants in the Atherosclerosis Risk in Communities study, the mean (SD) age was 63.0 (5.6) years, and 43.9% were male. Compared with nonusers, PPI users were more often of white race, obese, and taking antihypertensive medication. Proton pump inhibitor use was associated with incident CKD in unadjusted analysis (hazard ratio [HR], 1.45; 95% CI, 1.11-1.90); in analysis adjusted for demographic, socioeconomic, and clinical variables (HR, 1.50; 95% CI, 1.14-1.96); and in analysis with PPI ever use modeled as a time-varying variable (adjusted HR, 1.35; 95% CI, 1.17-1.55). The association persisted when baseline PPI users were compared directly with H₂ receptor antagonist users (adjusted HR, 1.39; 95% CI, 1.01-1.91) and with propensity score–matched nonusers (HR, 1.76; 95% CI, 1.13-2.74). In the Geisinger Health System replication cohort, PPI use was associated with CKD in all analyses, including a time-varying new-user design (adjusted HR, 1.24; 95% CI, 1.20-1.28). Twice-daily PPI dosing (adjusted HR, 1.46; 95% CI, 1.28-1.67) was associated with a higher risk than once-daily dosing (adjusted HR, 1.15; 95% CI, 1.09-1.21).

Conclusions and Relevance  Proton pump inhibitor use is associated with a higher risk of incident CKD. Future research should evaluate whether limiting PPI use reduces the incidence of CKD.

米国では、ピロリ菌の自然減少に伴い、萎縮性胃炎がなくなり、過多の胃酸による逆流性食道炎が増加し続けている。





その治療としてPPIが用いられる。2013年では1500万人以上にPPIが処方され、その原価は100億ドル（1兆2千万円）と言われる。（日本人口換算では4800億円）
 

日本での売り上げは、2013年では、タケプロン676億円、ネキシウム542億円、パリエット473億円である。

https://nk.jiho.jp/servlet/nk/related/html/1226663477655.html

慢性腎疾患の増加は、透析治療のさらなる増加（2011年でも30万人以上）となり、医療費の増大に直結する。

ピロリ菌が自然減少し続け、それでも除菌が行われ続け、欧米のデータに急速に近づいている日本の問題でもある。

 


日本でピロリ菌を除菌して、それによる胃がんの減少による費用対効果の計算では、日本でのピロリ菌感染の自然減少率が十分に考慮されていない。また、食道腺癌の増加の費用も考慮されていない。
さらに、 ピロリ菌による十二指腸潰瘍の発生よりも、
ピロリ菌を失うことによる逆流性食道炎の発生の方がはるかに多くなる。

つまり、ピロリ菌除菌によって、消化器系疾患だけでも、将来的に医療費が増加するが、
（PPIだけでも、米国と日本の人口比計算で、2000～3000億円増）

さらに、逆流性食道炎治療のPPI使用によって、腎疾患が増加して、さらに日本の医療費が増加してゆく可能性が高い。

※　PPI市場拡大のために何をすべきか？邪魔なのはピロリ菌と導かれれないか？
自由経済社会においては、そのようなフローチャート作成は自由である。
しかし、日本の医療費は税金で補填される。