Proton Pump Inhibitors and the Kidney: Implications of Current Evidence for Clinical Practice and When and How to Deprescribe

Ziyad Al-Aly, Geetha Maddukuri, Yan Xie

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations

Abstract

Proton pump inhibitors (PPIs), long thought to be safe, are associated with a number of nonkidney adverse health outcomes and several untoward kidney outcomes, including hypomagnesemia, acute kidney injury, acute interstitial nephritis, incident chronic kidney disease, kidney disease progression, kidney failure, and increased risk for all-cause mortality and mortality due to chronic kidney disease. PPIs are abundantly prescribed, rarely deprescribed, and frequently purchased over the counter. They are frequently used without medical indication, and when medically indicated, they are often used for much longer than needed. In this In Practice review, we summarize evidence linking PPI use with adverse events in general and adverse kidney outcomes in particular. We review the literature on the association of PPI use and risk for hypomagnesemia, acute kidney injury, acute interstitial nephritis, incident chronic kidney disease, kidney disease progression, end-stage kidney disease, and death. We provide an assessment of how this evidence should inform clinical practice. We review the impact of this evidence on patients’ perception of risk, synthesize PPI deprescription literature, and provide our recommendations on how to approach PPI use and deprescription.

Original languageEnglish
Pages (from-to)497-507
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume75
Issue number4
DOIs
StatePublished - Apr 2020

Keywords

  • H blockers
  • PPI
  • Proton pump inhibitors
  • acid suppression
  • acute interstitial nephritis (AIN)
  • acute kidney injury (AKI)
  • adverse events
  • all-cause mortality
  • causes of death
  • chronic kidney disease (CKD)
  • death
  • deprescribing
  • deprescription
  • drug safety
  • end-stage kidney disease (ESKD)
  • end-stage renal disease (ESRD)
  • gastroesophageal reflux disease (GERD)
  • histamine H-receptor antagonists
  • hypomagnesemia
  • kidney disease progression
  • magnesium
  • mortality
  • pharmacovigilance
  • review

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