title: Out-of-hospital use of proton pump inhibitors and hypomagnesemia at hospital admission: a nested case-control study.
abstract: BACKGROUND
  Case series suggest that long-term use of proton pump inhibitors (PPIs) is associated with hypomagnesemia, but the current literature lacks systematically collected data. Our aim was to examine whether hypomagnesemia at the time of hospital admission is associated with out-of-hospital use of PPIs.
  
  
  METHODS
  Nested case-control study matched for age and sex.
  
  
  METHODS
  Data were collected retrospectively from a tertiary acute-care facility. Eligible cases consisted of 402 adults with hypomagnesemia (serum magnesium <1.4 mEq/L) at the time of hospital admission to medical services, age- and sex-matched with 402 control individuals with normal serum magnesium levels (1.4-2.0 mEq/L).
  
  
  METHODS
  Out-of-hospital PPI use was identified in the hospital record. An omeprazole equivalent dose was calculated when possible. Covariates included the Charlson-Deyo comorbidity index, diabetes, diuretic use, estimated glomerular filtration rate, and gastroesophageal reflux.
  
  
  RESULTS
  Multivariable conditional logistic regression analyses were used to examine the association of PPI use with hypomagnesemia at the time of hospital admission.
  
  
  RESULTS
  PPI use was not associated with hypomagnesemia (adjusted OR, 0.82; 95% CI, 0.61-1.11). Neither PPI type nor omeprazole equivalent daily dose was associated with hypomagnesemia. Sensitivity analyses of PPI use restricted to patients with esophageal disorders (adjusted OR, 1.00; 95% CI, 0.69-1.45), severe hypomagnesemia (magnesium, ≤1.0 mEq/L; adjusted OR, 0.78; 95% CI, 0.13-4.61), or estimated glomerular filtration rate ≥60 mL/min/1.73 m(2) (adjusted OR, 0.84; 95% CI, 0.53-1.34) were unrevealing.
  
  
  CONCLUSIONS
  Exposure misclassification; hospitalized patients on medical services may not be representative of a broader ambulatory-based population.
  
  
  CONCLUSIONS
  In a hospital-based adult population, out-of-hospital PPI use is not associated with hypomagnesemia at the time of hospital admission to medical services. In light of these inconclusive results, prospective cohort studies are needed to address this rare potential medication-related adverse effect.
authors.affiliation: Department of Medicine, Division of Nephrology, Kidney and Dialysis Research Laboratory, St. Elizabeth's Medical Center, Boston, MA; Department of Medicine, Tufts University School of Medicine, Boston, MA.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Koulouridis
authors.forename: Mansour
authors.initials: M
authors.lastname: Alfayez
authors.forename: Hocine
authors.initials: H
authors.lastname: Tighiouart
authors.forename: Nicolaos E
authors.initials: NE
authors.lastname: Madias
authors.forename: David M
authors.initials: DM
authors.lastname: Kent
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Paulus
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D053565:Hypercalciuria / Q000453:epidemiology*; D008297:Male; D009397:Nephrocalcinosis / Q000453:epidemiology*; D010343:Patient Admission; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D015499:Renal Tubular Transport, Inborn Errors / Q000453:epidemiology*; D012189:Retrospective Studies
chemical_list: D054328:Proton Pump Inhibitors
keywords: Hypomagnesemia; electrolyte disorders; proton pump inhibitors (PPIs)