Use of proton pump inhibitors in dialysis unit in tertiary care hospital: a pharmaco-epidemiological study

Shabbir R. Pendhari, Kedar S. Joshi, Ramchandra P. Limaye


Background: Proton pump inhibitors (PPI) are generally thought to be safer drug with fewer adverse effects. Though this class of the drug is thought to be well tolerated, a detail study about actual use of these agents in nephrology department is still awaited in many parts of India. There had been case reports and case series which were reporting PPIs producing acute interstitial nephritis progressing to acute renal failure. The risk of PPI treatment in haemodialysis patients remains unexplored. The aim of the study was to evaluate a drug utilization of PPI in patient undergoing haemodialysis procedure.

Methods: In this study every day visit to the dialysis units of the hospitals was carried out. After taking consent from the patients, the information from the case-report form was noted like; age, sex, diagnosis, laboratory reports and drug prescried. No personally identifiable information about patient or physician was collected. After this an interview of patients was taken.

Results: In this study, out of 126 patients 76.6% were male and 23.4% were female. Out of these 126 patients 88.89% patients were on PPI. Nearly 54% were using PPI for more than six months. Nearly 29% patients were using PPI for more than 12 months.

Conclusions: As many case-reports and studies are suggesting, there is co-relation of PPI and acute interstitial nephritis from this study we suggest that especially in nephrology unit patients’, more caution must be exercised while using PPI.


PPI, Drug utilization study, Dialysis, AIN, ARF

Full Text:



WHO. Introduction to drug utilization research. What is drug utilization research and why is it needed? Geneva: WHO; 2003: 8-12.

Vanderhoff BT, Tahboub RM. Proton pump inhibitors: an update. Am Fam Physician. 2002;66(2):273-80.

Raghvendra B, Sanji N, Ullal SD, Kamath R, Pain MRSM, Kamath S, et al. Trends in prescribing gastroprotective agents with non-steroidal anti-inflammatory drugs in an orthopedic outpatient unit of a tertiary care hospital. J clin daog research. 2009;3:1553-6.

Nouseen, Tadvi NA, Shareef SM. Use of proton pump inhibitors ingeneral practice. is it rationale?. Int J Med Res Health Sci.2014;3;1:37-42.

Kaur S, Rajagopalan S, Kaur N, Shafiq N, Bhalla A, Pandhi P, Malhotra S. Drug utilization study in medical emergency unit of a tertiary care hospital in North India. Emerg Med Int. 2014;973578.

Barot PA, Malhotra SD, Rana DA, Patel VJ, Patel KP. Drug utilization in emergency medicine department at a tertiary care teaching hospital: A prospective study. J Basic Clin Pharm. 2013;4(4):78-81.

Pravinkumar L, Prakash HP, Vibhavari L. Study of rational prescribing and dispensing of preparations with nonsteroidal anti-inflammatory drugs in orthopedic outpatient department. Asian J Pharm Clin Res. 2015;4;4:278-81.

Tamilselvan T, Veerapandiyan AK, Karthik N. Study on drug utilization pattern of chronic renal failure patient in a tertiary care hospital. Int J Pharm Sci. 2014;6;9:482-84.

Churi S, Jogani A. Prospective assessment of prescribing pattern of intravenous proton pump inhibitors in an Indian tertiary care teaching hospital. Indian J Pharma Practice. 2004;7(4):2-7.

Geevasinga N, Patrik LC, Angela CW, Simon DR. Proton pump inhibitors and acute interstitial nephritis. Clin Gastro Hep. 2006;4:597-604.

Francisco ALM, Varas J, Ramos R, Merello JI, Canaud B, Stuard S, Pascual J, et al. Proton Pump Inhibitor Usage and the Risk of Mortality in Hemodialysis Patients. Kidney Int Rep. 2017;3(2):374-84.

Santra S, Agrawal D, Kumar S, Mishra SS. A study on the drug utilization pattern in patients with chronic kidney disease with emphasis on antibiotics. J Integr Nephrol role. 2015;2(3):85-9.

Misra PS, Alam A, Lipman ML, Nessium SJ. The relationship between proton pump inhibitor use and serum magnesium concentration among hemodialysis patients: a cross sectional study. BMC Nephrol. 2015;16:136-40.

Erdem E. Proton pump inhibitors use in hemodialysis patients and serum magnesium levels. Int J Clin Exp Med. 2015;8(11):21689-93.

Lee HJ, Lee H, Oh SH, Park J, Park S, Jeon JS, Noh H, Han DC, Kwon SH. Chronic kidney disease (CKD) patients are exposed to more proton pump inhibitor (PPI)s compared to non-CKD patients. PLoS One. 2018;13(9):203878.

Sampathkumar K, Ramlingam R, Prabhakar A, Abraham A. Acute interstitial nephritis due to proton pump inhibitors. Ind J Nephro. 2013;23(4):304-7.

Ray S, Delaney M, Mullar AF. Proton pump inhibitors and acute interstitial nephritis. BMJ. 2010;34:668-70.

Limaye RP, Pendhari SR, Joshi KS. Proton pump inhibitors: are they safe on kidneys: a histopathological study. Int J Basic Clin Pharmacol. 2016;5:1187-92.