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

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.