A notable association between chronic kidney disease (CKD) and gastroesophageal reflux disease (GERD) has been identified by a comprehensive meta-analysis involving over 4 million individuals.
A meta-analysis reveals a significant link between chronic kidney disease (CKD) and gastroesophageal reflux disease (GERD), highlighting the need for increased screening and awareness. | Image credit: dream@do – stock.adobe.com
The study, published in the Saudi Journal of Gastroenterology, showed a higher prevalence of GERD among people living with CKD, supporting the need for increased awareness and potential screening in this population.1
Patients with CKD commonly experience upper gastrointestinal dysfunction—including delayed gastric emptying and reduced small bowel secretions and absorption—likely linked to gut barrier disruption and endotoxemia rather than disease severity or hydration status.2
Researchers conducted a systematic review and meta-analysis of 9 studies. These studies, which included cross-sectional and case-control designs, encompassed a total of 4,650,709 participants. The objective was to evaluate the prevalence of GERD in people with CKD and to determine the strength of the association between the 2 conditions.
The systematic search spanned major databases from their inception up to November 2024. After an initial identification of 1821 studies and subsequent thorough screening, 9 studies met the inclusion criteria for the qualitative and quantitative synthesis. The included studies were geographically diverse, originating from the US, India, Taiwan, China, Iran, and the Philippines. The diagnosis of GERD in these studies was confirmed through various methods, including endoscopy, validated questionnaires, or official health databases.
Key findings from the meta-analysis revealed a pooled prevalence of GERD among people with CKD of 18% (95% CI, 10%-26%). This figure, while varying across individual studies, consistently pointed to a presence of GERD within the CKD community. For instance, prevalence rates ranged from 36.8% in a Korean study to 16% in an Indian study.
Furthermore, the analysis demonstrated a statistically significant association between CKD and GERD. The pooled crude OR for this association was calculated to be 2.53 (95% CI, 1.30-4.92). When adjusted for potential confounders, the pooled adjusted OR was 1.48 (95% CI, 1.05-2.08), indicating that people with CKD were nearly 1.5 times more likely to experience GERD compared with those without CKD.
While the exact pathophysiological mechanisms linking CKD and GERD remain an area for further research, the study’s discussion highlighted several proposed contributing factors. These included delayed gastric emptying, which can lead to prolonged exposure of the esophagus to stomach acid, and uremia, a condition associated with impaired kidney function. Other potential factors discussed were altered gastrointestinal motility, elevated gastrin levels, electrolyte imbalances, and endocrine disorders such as hyperparathyroidism.
The researchers acknowledged limitations in their study, particularly the high heterogeneity among the included studies, which suggested variations in diagnostic methods or study designs. They also noted the inherent risk of bias in observational studies, where certain confounding variables might not have been fully controlled. Despite these limitations, the authors concluded that the meta-analysis confirmed a marginally significant association between CKD and GERD.
The study author called for health care practitioners to consider screening for GERD symptoms in individuals diagnosed with CKD. This proactive approach could facilitate early detection and intervention, ultimately aiming to improve the quality of life for people living with chronic kidney disease. The authors emphasized the need for additional prospective studies to further elucidate the underlying mechanisms and to inform targeted interventions.
The authors concluded, “Given these findings, healthcare practitioners are advised to consider screening for GERD symptoms in individuals diagnosed with CKD. This facilitates the early detection of GERD and emphasizes the necessity for ongoing research to inform targeted interventions and improve quality of life of individuals with CKD.”
References
1. Chaponan-Lavalle A, Godoy A, Estrada-Grossmann JM, et al. Relationship between gastroesophageal reflux and chronic kidney disease: a meta-analysis of 4 million patients. Saudi J Gastroenterol. 2025;31(4):206-211. doi:10.4103/sjg.sjg_133_25
2. Grant CJ, Harrison LE, Hoad CL, et al. Patients with chronic kidney disease have abnormal upper gastro-intestinal tract digestive function: a study of uremic enteropathy. J Gastroenterol Hepatol. 2017 Feb;32(2):372-377. doi:10.1111/jgh.13458