Association of Helicobacter pylori eradication with proteinuria reduction and kidney outcomes: a systematic review and meta-analysis.
Shang-Yi Cai, Shang Shi, Heng-Jun Liu et al.
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In 30 seconds
This systematic review and meta-analysis assessed whether Helicobacter pylori eradication is associated with renal benefits in people with kidney disease or proteinuria. Across 16 studies, eradication was associated with reduced proteinuria or albuminuria (SMD -1.14, 95% CI -1.65 to -0.62; P < .001), although results varied substantially between studies (I2 = 91.5%). Observational data also linked earlier eradication with lower risk of incident chronic kidney disease. The findings suggest a possible renal benefit, but do not establish that eradication causes improved kidney outcomes.
Key findings
- Across 14 proteinuria/albuminuria datasets, eradication was associated with a reduction (SMD -1.14, 95% CI -1.65 to -0.62; P < .001).
- Heterogeneity in proteinuria/albuminuria results was substantial (I2 = 91.5%).
- Observational data associated earlier eradication with lower incident CKD risk (HR 0.68, 95% CI 0.52-0.88).
- The proteinuria effect was numerically larger in randomized trials than in non-randomized studies.
Why it matters
Proteinuria is a clinically relevant marker of kidney disease, and the pooled association raises the possibility that H. pylori infection may be a modifiable factor in proteinuric disease. However, substantial between-study heterogeneity and the observational basis of the CKD finding mean these results should be interpreted as evidence of a potential relationship, not proof that eradication improves renal outcomes.
What to keep in mind
The proteinuria/albuminuria analysis had substantial heterogeneity, and the evidence does not establish causality. The abstract calls for further well-designed randomized trials.