Proton-pump inhibitors and risk of renal disease

Introduction Proton pump inhibitors (PPIs) are one group of drugs that inhibit gastric acid secretion by binding irreversibly to the gastric proton pump. They include several different agents, such as omeprazole, pantoprazole, lansoprazole, deslansoprazole, etc. They are used in treatment of conditions such as duodenal and gastric ulcer, ZollingerEllison syndrome, gastro-esophageal reflux disease, Barrett’s esophagus and Helicobacter pylori infection of the upper gastro-intestinal tract. They are firstly introduced in the late 1980s (1). According to the U.S. Food and Drug Administration (FDA), about 21 million people have consumed one prescription of PPIs in the United States in 2009 (2). All PPIs possess a common mechanism of action for reducing parietal cell acid production by blocking gastric hydrogen potassium ATPase (1). The PPIs are known as one group of drugs that are welltolerated in healthy subjects and where serious harms are rare (2). In fact, the exposure to PPIs for kidney injury is not established yet, but there are several evidences that adumbrate on PPIs administration. The recent reports show an association between long-term prescription of PPIs and the appearance of adverse effects, for example; hyper-secretion of gastric acid after their withdrawal (3), with bone fracture (4) and low levels of magnesium in blood (5). Also, reducing the benefits of anti-platelet agents such as clopidogrel in patients with acute coronary syndromes, is followed by the inhibition of hepatic Mahrang Hedaiaty1, Mohammad Reza Tamadon2, Armin Amiri3, Leila Mahmoodnia4*