Association of Helicobacter pylori Eradication with Proteinuria Reduction and Kidney Outcomes: A Systematic Review and Meta-Analysis.

BACKGROUND

Helicobacter pylori infection has been implicated in systemic inflammation, but its role in kidney disease remains uncertain. We aimed to evaluate whether H. pylori eradication is associated with improved renal outcomes.

METHODS

We systematically reviewed studies of H. pylori eradication in patients with kidney disease or proteinuria. PubMed, Embase, Web of Science, Cochrane Library, and CNKI were searched up to March 2026. The primary outcome was change in proteinuria/albuminuria; secondary outcomes included incident CKD. Random-effects models calculated standardized mean differences (SMDs), odds ratios (ORs), and hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS

Sixteen studies were included. Thirteen studies provided 14 datasets for proteinuria/albuminuria (one study contributed two comparisons). H. pylori eradication was associated with a significant reduction in proteinuria/albuminuria (SMD -1.14, 95% CI -1.65 to -0.62; P < 0.001), with substantial heterogeneity (I2 = 91.5%). A numerically larger effect was seen in randomized trials than in non-randomized studies. Observational data indicated that earlier eradication was associated with a lower risk of incident CKD (HR 0.68, 95% CI 0.52-0.88).

CONCLUSION

H. pylori eradication is associated with lower proteinuria and may reduce renal risk. H. pylori infection might represent a modifiable factor in proteinuric kidney disease. However, given the heterogeneity and limitations of the evidence, causality remains unproven, and further well-designed randomized trials are required.