Design: Systematic review and meta-analysis (randomised and non-randomised studies)
Population: 16 studies of patients with kidney disease or proteinuria who had H. pylori eradication
Primary outcome: Change in proteinuria or albuminuria
Effect: SMD −1.14 (−1.65 to −0.62), I² 91.5%; incident CKD HR 0.68 (0.52–0.88) in observational data

A systematic review and meta-analysis in the Journal of Nephrology, published on 30 October, pooled 16 studies of Helicobacter pylori eradication in people with kidney disease or proteinuria.

Eradication was associated with a substantial fall in proteinuria or albuminuria, larger in the randomised trials than in non-randomised studies. Heterogeneity was very high (I² 91.5%). Observational data linked earlier eradication with a lower risk of developing CKD (HR 0.68).

The proposed mechanism is reduced systemic inflammation. The finding is intriguing for regions such as India where H. pylori is very common, but the studies vary widely and many come from single centres. It is not a reason to test everyone with proteinuria.

Where H. pylori is diagnosed for gastric reasons in a patient with proteinuric kidney disease, eradicating it is already indicated, and these data give an added reason not to defer.

Treat H. pylori when it is found in patients with proteinuric kidney disease; eradication is indicated anyway.
Do not screen all proteinuric patients for H. pylori on this evidence.
Adjust eradication regimen doses for kidney function where needed.
Recheck proteinuria after eradication as part of routine follow-up.

Why it matters

It raises a cheap, treatable infection as a possible contributor to proteinuria.

The statistics, in plain English

A standardised mean difference of −1.14 (95% CI −1.65 to −0.62) is large, but an I² of 91.5% means the studies disagreed sharply about the size of the effect, so the pooled figure is unreliable as a single estimate.