Lack of Association between Out-of-Hospital Use of Proton Pump Inhibitors and Hypomagnesemia at Hospital Admission: A Nested Case-Control Study.
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-c... read moreontrol 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 m2 (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
Thesis (M.S.)--Tufts University, 2012.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Bertrand Jaber.
Committee: Bertrand Jaber, David Kent, Tighiouart Hocine, and Nicolaos Madias.
Keywords: Medicine, Pharmacology, and Health sciences.read less