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. 2025 Mar 20;18(3):sfaf037.
doi: 10.1093/ckj/sfaf037. eCollection 2025 Mar.

Prophylactic proton pump inhibitor usage and new-onset acute kidney injury in critically ill patients: a retrospective analysis

Jing Xu  1 , Zhoucang Zhang  1 , Yujing Pan  1 , Xue Li  1 , Jiaxiang Ding  1 , Mei Wang  2
Affiliations

Prophylactic proton pump inhibitor usage and new-onset acute kidney injury in critically ill patients: a retrospective analysis

Jing Xu et al. Clin Kidney J. .

Abstract

Background: Proton pump inhibitors (PPIs) are widely prescribed for stress ulcer prophylaxis (SUP) in intensive care unit (ICU) patients. However, the potential association between prophylactic PPIs and the development of new-onset acute kidney injury (AKI) remains unclear.

Methods: Patients without AKI or end-stage renal disease and not undergoing renal replacement therapy upon admission to the ICU were identified from the Medical Information Mart for Intensive Care (MIMIC-IV) database. The exposure factor for the study was the initiation of prophylactic PPIs within 48 h of admission, with the primary outcome being the occurrence of new-onset AKI after 48 h. Multivariable regression models were employed to investigate the association between prophylactic PPIs and the risk of new-onset AKI. Various propensity score analyses, along with stratified and subgroup analyses and E-value calculations, were conducted to further evaluate the reliability of the results.

Results: A total of 7498 ICU patients were analyzed. The multivariable analysis showed a higher incidence of new-onset AKI in the PPI group (30.7%) compared with the control group (24.1%), yielding an adjusted odds ratio (OR) of 1.43 (95% confidence interval 1.22-1.67). Propensity score analyses confirmed these results, with ORs ranging from 1.34 to 1.49 (P ≤ .005). Results from multiple sensitivity analyses further supported these findings, with an E-value of 2.34 indicating robustness against unmeasured confounders.

Conclusions: Prophylactic PPI use is associated with an increased risk of new-onset AKI in ICU patients. Indiscriminate use of PPIs should be avoided.

Keywords: acute kidney injury (AKI); intensive care unit (ICU); proton pump inhibitors (PPIs); stress ulcer prophylaxis (SUP).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Flowchart of patient selection.
Figure 2:
Figure 2:
The association between prophylactic PPIs use and new-onset AKI in subgroups. The P-value for interaction represents the likelihood of interaction between the variable and the PPIs.
See this image and copyright information in PMC

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