Lack of Association between Out-of-Hospital Use of Proton Pump Inhibitors and Hypomagnesemia at Hospital Admission: A Nested Case-Control Study.

摘要

Background: Case series suggest that chronic use of proton pump inhibitors (PPIs) is associated with hypomagnesemia. Current literature lacks systematically collected data linking use of PPIs to hypomagnesemia. This study examines whether the presence of hypomagnesemia at time of hospital admission is associated with use of PPIs.;Study Design: Exact age and sex matched nested case-control study of 402 adult cases of hypomagnesemia at time of hospital admission, sex- and age-matched to 402 controls.;Setting and Participants: Data derived from abstracts of hospital discharges linked to the hospital's electronic laboratory database. Cases consisted of patients with hypomagnesemia (1.4 mEq/L) at time of hospital admission. Control subjects consisted of patients with normal serum magnesium level (1.4-2.0 mEq/L) at time of hospital admission. For each patient, we included the first available hospitalization documenting ICD-9-CM diagnosis code for disorders of the esophagus, stomach and duodenum.;Predictor and Outcome: PPI use before hospitalization was identified in the hospital record. When possible, omeprazole equivalent dose was calculated. Conditional logistic regression was performed to examine the association of PPI use with hypomagnesemia. Adjustment variables included the Charlson-Deyo comorbidity index, diabetes, use of thiazide diuretics, estimated glomerular filtration rate (eGFR), and presence of gastro-esophageal reflux.;Results: PPI use was not associated with hypomagnesemia (adjusted odds ratio [OR] 0.82; 95% CI 0.61, 1.11). Neither PPI type nor omeprazole equivalent daily dose was associated with hypomagnesemia. No significant association was shown in adjusted sensitivity analyses of PPI use restricted to patients with esophageal disorders (OR 1.00; 95% CI 0.69, 1.45), severe hypomagnesemia (≤1.0 mEq/L) (OR 0.78; 95% CI 0.13, 4.61), or eGFR>60 ml/min/1.73 m 2 (OR 0.84; 95% CI 0.53, 1.34).;Limitations: Confounding and ascertainment bias of PPI use; inability to ascertain length of PPI use; and study sample restricted to hospitalized patients.;Conclusions: In a hospital-based adult population, use of PPI was not associated with hypomagnesemia at hospital admission.