In adjusted analyses, they found that participants who used PPIs at baseline had a significantly increased risk of incident CKD compared with nonusers. Similar associations were seen in the Geisinger Health System replication cohort of 248,751 participants, where incident CKD was defined as sustained eGFR,60 ml/min per 1.73 m2 or development of ESRD. In addition, twice-daily PPI dosing was shown to be associated with a higher risk of CKD than once-daily dosing. The study by Lazarus et al., and this study, reached remarkably similar conclusions using comparable study designs but in unrelated, population-based cohorts. Our study adopted a new user design, on the basis of pharmacy records, where the primary