Summary: In a randomised trial in diabetic kidney disease, the acid-suppressing drug vonoprazan reduced albuminuria and improved kidney filtration more than lansoprazole over three months, independent of H. pylori status, suggesting a possible direct renal effect that needs confirmation.
PICO Summary
| Element | Detail |
|---|---|
| Population | 140 adults with diabetic kidney disease (100 needing H. pylori eradication, 40 for other indications); randomised controlled trial, Egypt. |
| Intervention | Vonoprazan 20 mg daily for 3 months. |
| Comparison | Lansoprazole 30 mg daily for 3 months. |
| Outcome | Both drugs reduced the albumin/creatinine ratio, but the reduction was significantly greater with vonoprazan, regardless of H. pylori diagnosis or eradication (treatment effect β=19.2; 95% CI 13.6–24.8 for percentage change in ACR). Vonoprazan also improved eGFR compared with lansoprazole. No significant adverse events. |
Vonoprazan and albuminuria in diabetic kidney disease
RCT · diabetic kidney disease · 3 months
Vonoprazan cut albuminuria more than lansoprazole over 3 months, with a treatment effect of +19.2 percentage points (95% CI 13.6–24.8) in ACR change and superior eGFR. A short single-centre surrogate signal, not a reason to prescribe it for the kidney.
Expert Commentary
This is an intriguing and somewhat unexpected trial, since vonoprazan is a potassium-competitive acid blocker used for acid-related disease, and a renal benefit in diabetic kidney disease would be a genuine surprise that demands cautious interpretation. The signal itself is reasonably clean, with a significantly greater fall in albuminuria and better eGFR than the comparator, and the persistence of the effect regardless of H. pylori status is the key point, because it argues the benefit is not simply a consequence of treating infection or inflammation but may reflect a direct renal mechanism. That said, the appropriate posture is curiosity rather than adoption. This is a single-centre study of 140 patients over only three months, the comparator was another acid suppressant rather than placebo or standard renoprotective therapy, the mechanism is unknown and hypothesis-level, and short-term albuminuria change is a surrogate rather than a hard renal outcome. Can I use this with my patients? Not as a renal therapy. I would not prescribe vonoprazan to reduce albuminuria, where proven options such as RAS blockade, SGLT2 inhibitors, and finerenone remain the priorities, but this is a legitimate signal worth following in larger, longer, mechanistically focused and placebo-controlled trials.
References
Ahmed RM, Soliman AR, Mohammed A. Vonoprazan attenuates proteinuria in diabetic kidney disease through potential direct renal mechanism. Sci Rep. 2025;15(1):41446. doi:10.1038/s41598-025-25376-8