LONG-TERM USE OF TEGOPRAZAN AND THE RISK OF END-STAGE KIDNEY DISEASE PROGRESSION: A KOREAN NATIONWIDE STUDY

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Abstract Title *

LONG-TERM USE OF TEGOPRAZAN AND THE RISK OF END-STAGE KIDNEY DISEASE PROGRESSION: A KOREAN NATIONWIDE STUDY

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Co-author 1

Jinmi Kim jinmi@pusan.ac.kr Pusan National University Hospital Department of Biostatistics Busan Korea (Republic of) *

Co-author 2

Harin Rhee rheeharin@pusan.ac.kr Pusan National University School of Medicine Department of Internal Medicine Busan Korea (Republic of) -

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Introduction

Tegoprazan, a potassium-competitive acid blocker (P-CAB), has been widely prescribed in South Korea since 2018. Despite its increasing use, data on the long-term renal safety of tegoprazan, especially in patients with chronic kidney disease (CKD), remains limited. This study aimed to assess the long-term effect of tegoprazan on progression to end-stage kidney disease (ESKD) among CKD stage 3–4 patients.

Methods

We conducted a nationwide, retrospective cohort study using the Korean Health Insurance Review and Assessment (HIRA) database from 2013 to 2022. Patients with CKD stages 3–4 who were newly prescribed tegoprazan were matched 1:1 by propensity score with those receiving histamine-2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs). The composite outcome was all-cause mortality or ESKD. Hazard ratios (HRs) were estimated using Cox proportional hazards models, and a network meta-analysis was performed to integrate pairwise comparisons.

Results

After matching, 674, 902, and 4,583 pairs were included in the tegoprazan–H2RA, tegoprazan–PPI, and PPI–H2RA comparisons, respectively. The mean age exceeded 75 years, and comorbidities were frequent (hypertension 85%, diabetes 45%, ischemic heart disease 28%).

Long-term tegoprazan use was not associated with increased risk of death or ESKD compared with H2RAs (HR 0.91, 95% CI 0.66–1.26, p=0.565) or PPIs (HR 0.87, 95% CI 0.66–1.15, p=0.321). The network meta-analysis confirmed consistent findings across treatment groups.

Conclusion

Among patients with CKD stages 3–4, long-term tegoprazan use did not significantly increase the risk of death or ESKD progression compared with H2RAs or PPIs. These findings suggest no apparent renal toxicity signal associated with tegoprazan use. Further prospective studies are warranted to confirm its long-term renal safety.

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