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Research

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

Tony Antoniou, Erin M. Macdonald, Simon Hollands, Tara Gomes, Muhammad M. Mamdani, Amit X. Garg, J. Michael Paterson and David N. Juurlink
April 16, 2015 3 (2) E166-E171; DOI: https://doi.org/10.9778/cmajo.20140074
Tony Antoniou
1Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ont.
2Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ont.
3Institute for Clinical Evaluative Sciences, Toronto, Ont.
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Erin M. Macdonald
3Institute for Clinical Evaluative Sciences, Toronto, Ont.
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Simon Hollands
3Institute for Clinical Evaluative Sciences, Toronto, Ont.
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Tara Gomes
2Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ont.
3Institute for Clinical Evaluative Sciences, Toronto, Ont.
4Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.
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Muhammad M. Mamdani
2Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ont.
3Institute for Clinical Evaluative Sciences, Toronto, Ont.
4Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.
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Amit X. Garg
3Institute for Clinical Evaluative Sciences, Toronto, Ont.
5Division of Nephrology, Department of Medicine, Western University, London, Ont.
6Department of Epidemiology and Biostatistics, Western University, London, Ont.
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J. Michael Paterson
3Institute for Clinical Evaluative Sciences, Toronto, Ont.
7Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.
8Department of Family Medicine, McMaster University, Hamilton, Ont.
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David N. Juurlink
3Institute for Clinical Evaluative Sciences, Toronto, Ont.
9Departments of Medicine and Pediatrics, University of Toronto, Toronto, Ont.
10Sunnybrook Research Institute, Toronto, Ont.
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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.

  • © 2015, 8872147 Canada Inc. or its licensors
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CMAJ Open: 3 (2)
Vol. 3, Issue 2
1 Apr 2015
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Proton pump inhibitors and the risk of acute kidney injury in older patients: a population-based cohort study
Tony Antoniou, Erin M. Macdonald, Simon Hollands, Tara Gomes, Muhammad M. Mamdani, Amit X. Garg, J. Michael Paterson, David N. Juurlink
Jan 2015, 3 (2) E166-E171; DOI: 10.9778/cmajo.20140074

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Proton pump inhibitors and the risk of acute kidney injury in older patients: a population-based cohort study
Tony Antoniou, Erin M. Macdonald, Simon Hollands, Tara Gomes, Muhammad M. Mamdani, Amit X. Garg, J. Michael Paterson, David N. Juurlink
Jan 2015, 3 (2) E166-E171; DOI: 10.9778/cmajo.20140074
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