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Start Over Author "Mark, Roger G" Journal journal of clinical pharmacology
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2. Proton Pump Inhibitors Are Not Associated With Acute Kidney Injury in Critical Illness.

Author

Lee, Joon, Mark, Roger G., Celi, Leo Anthony, and Danziger, John

Subjects
*ACUTE kidney failure, *COMPARATIVE studies, *CONFIDENCE intervals, *CRITICALLY ill, *EPIDEMIOLOGICAL research, *LONGITUDINAL method, *PATIENTS, *ODDS ratio, *PROTON pump inhibitors, *H2 receptor antagonists, *THERAPEUTICS, *DISEASE risk factors
Abstract

Recent epidemiologic data linking proton pump inhibitor (PPI) use to acute and chronic kidney dysfunction is yet to be validated in other populations, and mechanisms have not been explored. Using a large, well phenotyped inception cohort of 15 063 critically ill patients, we examined the risk of acute kidney injury (AKI), as defined by the Kidney Disease Improving Global Outcomes criteria guidelines, according to prior use of a PPI, histamine-2 receptor antagonist (H2RA), or neither. A total of 3725 (24.7%) patients reported PPI use prior to admission, while 905 (6.0%) patients reported H2RA use. AKI occurred in 747 (20.0%) and 163 (18.0%) of PPI and H2RA users respectively, compared to 1712 (16.2%) of those not taking acid suppressive medications. In unadjusted analysis, PPI and H2RA users had a 28% (95%CI 1.17-1.41, P < .001) and 10% (95%CI 0.91-1.30, P = .31) higher risk of AKI compared to those taking neither class of medication. However, in sequential models that included adjustment for demographics, cardiovascular comorbidities, indications for PPI use, and severity of illness, the effect of PPI on the risk of AKI was attenuated, and in the adjusted analysis, PPI was not associated with AKI (OR 1.02; 95%CI 0.91-1.13, P = .73). The presence of sterile pyuria and hypomagnesemia did not modify the association between PPI use and AKI. In summary, after adjustment for demographics, illness severity, and the indication for PPI use, PPI use prior to admission is not associated with critical illness AKI. [ABSTRACT FROM AUTHOR]

Published
2016
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3. Proton pump inhibitor use is not associated with cardiac arrhythmia in critically ill patients

Author

Mengling Feng, John Danziger, Roger G. Mark, Kenneth P. Chen, Brian E. Malley, Joon Lee, Leo Anthony Celi, Institute for Medical Engineering and Science, Harvard University--MIT Division of Health Sciences and Technology, Mark, Roger G, Lee, Joonwu, Feng, Mengling, and Celi, Leo Anthony G.

Subjects
Male, Risk, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Critical Illness, Proton-pump inhibitor, Article, Hypomagnesemia, Electrocardiography, Internal medicine, medicine, Humans, Pharmacology (medical), Magnesium, cardiovascular diseases, Diuretics, Aged, Retrospective Studies, Pharmacology, Aged, 80 and over, medicine.diagnostic_test, business.industry, Antagonist, Cardiac arrhythmia, Retrospective cohort study, Arrhythmias, Cardiac, Proton Pump Inhibitors, Middle Aged, medicine.disease, Histamine H2 Antagonists, Cardiology, cardiovascular system, Observational study, Female, Diuretic, business
Abstract

Hypomagnesemia can lead to cardiac arrythmias. Recently, observational data have linked chronic proton pump inhibitor (PPI) exposure to hypomagnesemia. Whether PPI exposure increases the risk for arrhythmias has not been well studied. Using a large, single-center inception cohort of critically ill patients, we examined whether PPI exposure was associated with admission electrocardiogram readings of a cardiac arrhythmia in more than 8000 patients. There were 25.4% PPI users, whereas 6% were taking a histamine 2 antagonist. In all, 14.0% had a cardiac arrhythmia. PPI use was associated with an unadjusted risk of arrhythmia of 1.15 (95% CI,1.00–1.32; P =.04) and an adjusted risk of arrhythmia of 0.91 (95% CI, 0.77–1.06; P =.22). Among diuretic users (n = 2476), PPI use was similarly not associated with an increased risk of cardiac arrhythmia. In summary, in a large cohort of critically ill patients, PPI exposure is not associated with an increased risk of cardiac arrhythmia., National Institutes of Health (U.S.) (NIH Grant R01 EB017205)

Published
2014

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