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

      , ,
      American Journal of Kidney Diseases
      Elsevier BV

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          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.

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          Author and article information

          Journal
          American Journal of Kidney Diseases
          American Journal of Kidney Diseases
          Elsevier BV
          02726386
          October 2019
          October 2019
          Article
          10.1053/j.ajkd.2019.07.012
          31606235
          4a98c192-9629-4077-8114-94acdabe6091
          © 2019

          https://www.elsevier.com/tdm/userlicense/1.0/


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