[Association of proton pump inhibitor management strategies with clinical outcomes in patients with hospital-acquired acute kidney injury].

Authors

F Y Chen, T Li, X H Liu, Y Zhang, B Y Wu, K Liu, L Li, H J Mao

Published in

Zhonghua yi xue za zhi. Volume 106. Issue 36. Pages 3866-3874. Sep 29, 2026.

Abstract

Objective: To investigate the association between continuation, discontinuation, or dose reduction of proton pump inhibitor (PPI) and clinical outcomes in patients with hospital-acquired acute kidney injury (AKI). Methods: This retrospective cohort study included patients hospitalized in Jiangsu Province Hospital between January 2021 and June 2025. According to the PPI management strategy within 48 hours after diagnosis of hospital-acquired AKI, patients were divided into a continued-use group, a dose-reduction group, and a discontinuation group. The primary outcome was 30-day AKI progression, and the secondary outcomes were 30-day kidney replacement therapy (KRT) requirement and non-recovery of renal function before discharge. Propensity score matching was used to control for confounding bias. Matching variables included demographic characteristics, laboratory indicators, AKI stage, comorbidities, indications for PPI use, concomitant medications, and life-support treatments. After matching, outcomes were evaluated using conditional logistic regression models. The primary analysis compared outcomes between the continued-use and discontinuation groups, while exploratory analyses compared outcomes between the dose-reduction group and the other two groups. Results: A total of 2 203 patients with hospital-acquired AKI were included, with a median (Q₁, Q₃) age of 67.0 years (56.0, 74.0), and 1 526 patients (69.3%) were male. There were 1 273 patients in the continued-use group, 525 in the dose-reduction group, and 405 in the discontinuation group, respectively. After propensity score matching, 391 patients in each of the continued-use and discontinuation groups were included in the primary analysis. The primary analysis showed that, compared with discontinuation, continued PPI use was associated with increased risks of 30-day AKI progression (OR=1.45, 95%CI: 1.03-2.03, P=0.032) and 30-day KRT requirement (OR=2.61, 95%CI: 1.76-3.87, P<0.001), while there was no statistically significant difference in non-recovery of renal function before discharge (OR=0.90, 95%CI: 0.66-1.23, P=0.514). Exploratory analyses of the dose-reduction strategy showed that, compared with continued use, dose reduction was associated with lower risks of 30-day AKI progression (OR=0.59, 95%CI: 0.44-0.80, P<0.001) and KRT requirement (OR=0.69, 95%CI: 0.50-0.93, P=0.016). Compared with the discontinuation group, the dose-reduction group showed no statistically significant difference in 30-day AKI progression (OR=0.67, 95%CI: 0.43-1.04, P=0.075), but was associated with a higher risk of 30-day KRT requirement (OR=1.67, 95%CI: 1.05-2.67, P=0.030) and a lower risk of non-recovery of renal function before discharge (OR=0.62, 95%CI: 0.39-0.97, P=0.036). Conclusions: Among patients with AKI who have been using PPI before AKI diagnosis, continued PPI use after AKI is associated with higher short-term risks of AKI progression and KRT requirement. PPI dose reduction may reduce the risk of some adverse renal events.

PMID:
42778316
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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