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.