Association Between Helicobacter pylori Infection and Chronic Kidney Disease

Chronic kidney disease. Computer illustration showing the gross anatomy of kidneys with chronic glomerulonephritis. The kidneys are atrophied with a thin cortex and cysts that create a bumpy appearance. The chronic form of glomerulonephritis may develop in adults following a streptococcal throat infection. It is seen clinically as in low urine production (oliguria), high blood pressure and urea retention.
Investigators evaluated the relationship among Helicobacter pylori infection, atrophic gastritis, and chronic kidney disease.

Study data published in Healthcare outlined the association between Helicobacter pylori infection and chronic kidney disease (CKD). In patients without established gastric dysfunction, the presence of H pylori infection was associated with increased risk for CKD; however, patients with both atrophic gastritis (AG) and H pylori infection appeared to be at decreased risk for CKD compared with control participants.

Although prior research suggested that H pylori infection may affect kidney outcomes, its precise effect on CKD incidence remains unclear. To clarify the relationship between gastric and renal dysfunction, investigators performed a cross-sectional study of individuals enrolled in the Japan Multi-Institutional Collaborative Cohort Study between 2011 and 2013.

Enrollees in this cohort study were Japanese adults willing to provide lifestyle-related data over a period of a few years. Researchers captured demographic information and medical history by self-report questionnaires and defined CKD as having an estimated glomerular filtration rate <60 mL/min/1.73 m2; AG diagnosis was determined according to serum pepsinogen levels.

The investigators identified infection with H pylori via laboratory testing and used multivariable logistic regression models to assess the relationship among H pylori infection, AG, and CKD. Models were adjusted for demographic and clinical covariates, including comorbid medical conditions.

The total cohort comprised 3560 adults, among whom 1127 (31.7%) were men and 2433 (68.3%) were women. Participating adults were divided into 4 diagnostic categories according to H pylori infection and AG diagnosis: persons with neither H pylori infection nor atrophic gastritis (HP−/AG−) (n=2430); persons with H pylori infection and without AG (HP+/AG−) (n=552); persons with both H pylori infection and AG (HP+/AG+) (n=517); and persons without H pylori infection and with AG (HP−/AG+) (n=61).

Mean age was 50±10.1 years in the control group (HP−/AG−) and >54 years in remaining strata. In age- and sex-adjusted regression models, the HP+/AG− group had significantly increased risk for CKD (adjusted odds ratio [aOR] 1.47; 95% CI, 1.07-2.01; P =.018) relative to the control group. This association persisted after adjusting for clinical covariates, including body mass index, tobacco and alcohol use, and cardiac comorbidities.

By contrast, the HP+/AG+ group had substantially reduced odds for CKD compared with control participants (aOR 0.61; 95% CI, 0.41-0.92; P =.017) in adjusted models. The HP−/AG+ group showed no significant association with CKD in either direction.

In this cross-sectional study, H pylori infection appeared to be associated with CKD risk in adults without AG; however, dual diagnosis with H pylori infection and AG was mildly protective against CKD. Investigators hypothesized that the relationship between H pylori infection and kidney dysfunction may be driven by reduction of ghrelin secretion; but the present study did not capture ghrelin levels. Therefore, further research is necessary to investigate this hypothesis.

“We demonstrated that… H pylori, an important pathogenic factor in the stomach, is probably involved in the development of many other diseases,” the study authors wrote. “Uncovering the association between gastric and renal conditions could lead to the development of new treatment strategies.”


Hata K, Koyama T, Ozaki E, et al. Assessing the relationship between Helicobacter pylori and chronic kidney disease. Healthcare (Basel). 2021;9(2):162. doi: 10.3390/healthcare9020162