Proton pump inhibitors are among the most frequently prescribed drugs in the world and are generally considered safe. However, there is growing concern regarding their safety. World's leading journals say PPIs are not as safe as thought to be. Proton-pump inhibitors (PPIs) are a widely prescribed class of medications used to treat acid-related disorders and its use has significantly increased over the last few decades. PPIs are often inappropriately prescribed; since they have been in the market. According to one study, it was observed that 46.7% of patients taking PPIs were ≥ 65 years of age who have compromised renal functions. Additionally, in approximately 40% of older adults, there was no indication for long-term PPI use identified. Adding to it, patients continue consuming PPIs way beyond the doctor’s advice. A number of post-marketing studies have been published in the past demonstrating associations between longer duration of PPI therapy and a number of adverse effects that are a concern. PPIs have been associated with an increased risk of a number of adverse effects including AIN, CKD, KIDNEY DISEASE, ESRD osteoporotic-related fractures, Clostridium difficile infection, community-acquired pneumonia, vitamin B12 deficiency.

1. NEW GUIDELINES & RECCOMMENDATIONS
WHAT ARE NEW
STUDIES AND THEIR
CONCLUSIONS…?
Visit: www.ppialerts.blogspot.com

2. Advent of PPIs -
PANTOPRAZOLE, RABEPRAZOLE, OMEPRAZOLE, ESOMEPRAZOLE, LANSOPRAZOLE, ILAPRAZOLE
Approximate years Published online before print April 14, 2016, doi:10.1681/ASN.2015121377JASN April 14, 2016ASN.2015121377

3. Eminent Journals
In recent times
…and many other journals world wide
REPEATEDLY
Confirming it…

4. Old and new findings?
• PPIs & KIDNEY disease.
• PPIs & KIDNEY Progression ESRD, CKD etc.,
• PPIs & acute kidney injury & acute interstitial nephritis.
• PPIs and DEMENTIA
• Increased risk of Myocardial infarction (heart attack) associated with PPIs (even
in general population)
• PPIs & ischemic cardiovascular events.
• PPIs and Endothelial AGING
• PPIs with ASPIRIN – Higher mortality rates.
• PPIs & Anaemia.
• PPIs & Clopidogrel.
• PPIs & Hyperparathyroidism.
• PPIs & Clostridium difficile associated GI infections.
• PPIs & Hypomagnesaemia.
• PPIs hampering absorption of Vit-B12, Iron, Calcium

5. 2019: PPIs increase the risk of CKD by 52% in diabetic
patients when the dosage is over 180 DDD in one year.
2018: PPI use is associated with a higher risk of
incident CKD. This association is greater for high
doses and becomes apparent after three months'
exposure
2018: The prevalence of PPIs prescription among CKD
patients was higher than in the non-CKD group
(p<0.001).
2018: PPI use increases the risk of AKI development,
and that PPI use is more significantly associated with
acute and chronic renal injuries in younger patients
STUDIES & CONCLUSIONS

6. 2017: Initiation of PPI therapy and cumulative PPI
exposure is associate with increased risk of CKD
progression (b) There was a graded association
between cumulative exposure to PPIs and risk of CKD
progression.
2017: PPI use is associated with increased risk of
chronic renal outcomes in the absence of intervening
AKI.
2016: PPI exposure associates with increased risk of
incident CKD, CKD progression, and ESRD
STUDIES & CONCLUSIONS

7. 2018: Use of proton pump inhibitors was
associated with a significantly increased
risk of acute kidney injury
2018: Using PPIs presented 1.4-fold
higher odds of CKD in Taiwan health
insurance claims data analysis.
STUDIES & CONCLUSIONS

8. 2016: PPIs was independently associated with a 20% to
50% higher risk of incident CKD
2016: Confirmed association PPIs with…CKD,
Progression of ESRD, Doubling of Serum
creatinine.
2015: PPI Therapy had increased risk of acute
kidney injury and acute interstitial nephritis
STUDIES & CONCLUSIONS

9. 2015 PLOS - General Population
• PPI consumption increases chances of MI In
general population also
2014 Japan - Hypomagnesemia
• Log term PPI intake induces hypomagnesemia
2013 & 2016 AHA – Circulation
THE ADMA PATHWAY & PPI induced Endothelial
aging.
2011 PPI Interaction with Clopidogrel
• PPI & Clopidogrel: similar CYP2 pathway, PPI
reduces clopidogrel action by almost 45%
STUDIES & CONCLUSIONS

10. NEW GUIDELINES & RECCOMMENDATIONS
Published online before print April 14, 2016, doi:10.1681/ASN.2015121377JASN April 14, 2016ASN.2015121377
Others Risk of
MI, Dementia,
Interaction with
Clopidogrel /
aspirin etc
AIN / AKI
/ CKD /
ESRD
Long
Term
PPIs
PANTOPRAZOLE,
RABEPRAZOLE,
OMEPRAZOLE,
ESOMEPRAZOLE,
LANSOPRAZOLE,
ILAPRAZOLE
Majority of it happens due to Self-Medication
Need is to educate patients

11. Many more journals and repeatedly
confirming
Visit: www.ppialerts.blogspot.com