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

Authors

  • Sourabh Sharma Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India;
  • Pawan Rawal Department of Gastroenterology, Institute of Digestive and Hepatobiliary Sciences, Medanta Hospital, Gurgaon, India;
  • Sanjay Kalra Department of Endocrinology, Bharti Hospital, Karnal, India; University Centre for Research & Development, Chandigarh University, Mohali, India.

DOI:

https://doi.org/10.47391/JPMA.25-94

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.
Keywords: Acid suppression, Chronic kidney disease, Gut
microbiome, Nephrotoxicity, Proton pump inhibitors

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Published

2025-10-21

How to Cite

Sourabh Sharma, Pawan Rawal, & Sanjay Kalra. (2025). Gut Guardianship: Recommendations for Rational Use of Proton Pump Inhibitors in Chronic Kidney Disease. Journal of the Pakistan Medical Association, 75(11), 1822–1824. https://doi.org/10.47391/JPMA.25-94

Issue

Vol. 75 No. 11 (2025): NOVEMBER - 2025

Section

ADVANCES IN NEPHROLOGY

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Copyright (c) 2025 Journal of the Pakistan Medical Association

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