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2015 ; 3
(2
): E166-71
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Proton pump inhibitors and the risk of acute kidney injury in older patients: a
population-based cohort study
#MMPMID26389094
Antoniou T
; Macdonald EM
; Hollands S
; Gomes T
; Mamdani MM
; Garg AX
; Paterson JM
; Juurlink DN
CMAJ Open
2015[Apr]; 3
(2
): E166-71
PMID26389094
show ga
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.