Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Apr 2;3(2):E166-71.
doi: 10.9778/cmajo.20140074. eCollection 2015 Apr-Jun.

Proton pump inhibitors and the risk of acute kidney injury in older patients: a population-based cohort study

Tony Antoniou  1 , Erin M Macdonald  2 , Simon Hollands  2 , Tara Gomes  3 , Muhammad M Mamdani  3 , Amit X Garg  4 , J Michael Paterson  5 , David N Juurlink  6
Affiliations

Proton pump inhibitors and the risk of acute kidney injury in older patients: a population-based cohort study

Tony Antoniou et al. CMAJ Open. .

Abstract

Background: Proton pump inhibitors (PPIs) cause interstitial nephritis and are an underappreciated cause of acute kidney injury. We examined the risk of acute kidney injury and acute interstitial nephritis in a large population of older patients receiving PPIs.

Methods: We conducted a population-based study involving Ontario residents aged 66 years and older who initiated PPI therapy between Apr. 1, 2002, and Nov. 30, 2011. We used propensity score matching to establish a highly comparable reference group of control patients. The primary outcome was hospital admission with acute kidney injury within 120 days, and a secondary analysis examined acute interstitial nephritis. We used Cox proportional hazards regression to adjust for differences between groups.

Results: We studied 290 592 individuals who commenced PPI therapy and an equal number of matched controls. The rates of acute kidney injury (13.49 v. 5.46 per 1000 person-years, respectively; hazard ratio [HR] 2.52, 95% CI 2.27 to 2.79) and acute interstitial nephritis (0.32 vs. 0.11 per 1000 person-years; HR 3.00, 95% CI 1.47 to 6.14) were higher among patients given PPIs than among controls.

Interpretation: In our study population of older adults, those who started PPI therapy had an increased risk of acute kidney injury and acute interstitial nephritis. These are potentially reversible conditions that may not be readily attributed to drug treatment. Clinicians should appreciate the risk of acute interstitial nephritis during treatment with PPIs, monitor patients appropriately and discourage the indiscriminate use of these drugs.

PubMed Disclaimer

Conflict of interest statement

Competing interests:During the past 3 years, Muhammad Mamdani has been on advisory boards and/or received honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Company, GlaxoSmithKline, Hoffmann–La Roche, Novartis, Novo Nordisk and Pfizer. Amit X. Garg’s institution has received an unrestricted educational grant from Pfizer. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Kaplan–Meier curves for admission to hospital with acute kidney injury, by group.
See this image and copyright information in PMC

References

    1. Praga M. González. Acute interstitial nephritis. Kidney Int 2010;77:956-61. - PubMed
    1. Perazella MA, Markowitz GS. Drug-induced acute interstitial nephritis. Nat Rev Nephrol 2010;6:461-70. - PubMed
    1. Proton pump inhibitors BOCA drug use review and duration of use analysis Silver Spring (MD): Food and Drug Administration; 2010. Available: www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/pedi... (accessed 2013 Aug. 13).
    1. Sierra F, Suarez M, Rey M, et al. Systematic review: proton pump inhibitor-associated acute interstitial nephritis. Aliment Pharmacol Ther 2007;26:545-53. - PubMed
    1. Ray S, Delaney M, Fuller AF. Proton pump inhibitors and acute interstitial nephritis. BMJ 2010;341:c4412. - PubMed