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Meta-Analysis
. 2014 Nov 13;9(11):e112558.
doi: 10.1371/journal.pone.0112558. eCollection 2014.

The association between the use of proton pump inhibitors and the risk of hypomagnesemia: a systematic review and meta-analysis

Chan Hyuk Park  1 , Eun Hye Kim  1 , Yun Ho Roh  2 , Ha Yan Kim  2 , Sang Kil Lee  1
Affiliations
Meta-Analysis

The association between the use of proton pump inhibitors and the risk of hypomagnesemia: a systematic review and meta-analysis

Chan Hyuk Park et al. PLoS One. .

Abstract

Background: Although many case reports have described patients with proton pump inhibitor (PPI)-induced hypomagnesemia, the impact of PPI use on hypomagnesemia has not been fully clarified through comparative studies. We aimed to evaluate the association between the use of PPI and the risk of developing hypomagnesemia by conducting a systematic review with meta-analysis.

Methods: We conducted a systematic search of MEDLINE, EMBASE, and the Cochrane Library using the primary keywords "proton pump," "dexlansoprazole," "esomeprazole," "ilaprazole," "lansoprazole," "omeprazole," "pantoprazole," "rabeprazole," "hypomagnesemia," "hypomagnesaemia," and "magnesium." Studies were included if they evaluated the association between PPI use and hypomagnesemia and reported relative risks or odds ratios or provided data for their estimation. Pooled odds ratios with 95% confidence intervals were calculated using the random effects model. Statistical heterogeneity was assessed with Cochran's Q test and I2 statistics.

Results: Nine studies including 115,455 patients were analyzed. The median Newcastle-Ottawa quality score for the included studies was seven (range, 6-9). Among patients taking PPIs, the median proportion of patients with hypomagnesemia was 27.1% (range, 11.3-55.2%) across all included studies. Among patients not taking PPIs, the median proportion of patients with hypomagnesemia was 18.4% (range, 4.3-52.7%). On meta-analysis, pooled odds ratio for PPI use was found to be 1.775 (95% confidence interval 1.077-2.924). Significant heterogeneity was identified using Cochran's Q test (df = 7, P<0.001, I2 = 98.0%).

Conclusions: PPI use may increase the risk of hypomagnesemia. However, significant heterogeneity among the included studies prevented us from reaching a definitive conclusion.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow diagram of studies included in the meta-analysis.
PPI, proton pump inhibitor.
Figure 2
Figure 2. Forest plots for risk of hypomagnesemia.
PPI, proton pump inhibitor; CI, confidence interval.
Figure 3
Figure 3. Subgroup analysis for studies which included only hospitalized patients.
PPI, proton pump inhibitor; CI, confidence interval.
Figure 4
Figure 4. Subgroup analysis according to the cut-off value of serum magnesium levels.
(A) Subgroup analysis for studies based on the 1.7 mg/dL of cut-off value. (B) Subgroup analysis for studies based on the 1.8 mg/dL of cut-off value. PPI, proton pump inhibitor; CI, confidence interval.
See this image and copyright information in PMC

Comment in

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