title: Proton pump inhibitors linked to hypomagnesemia: a systematic review and meta-analysis of observational studies.
abstract: BACKGROUND
  The reported risk of hypomagnesemia in patients with proton pump inhibitor (PPI) use is conflicting. The objective of this meta-analysis was to assess the association between the use of PPIs and the risk of hypomagnesemia.
  
  
  METHODS
  A literature search of observational studies was performed using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews from inception through September 2014. Studies that reported odd ratios or hazard ratios comparing the risk of hypomagnesemia in patients with PPI use were included. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
  
  
  RESULTS
  Nine observational studies (three cohort studies, five cross-sectional studies and a case-control study) with a total of 109,798 patients were identified and included in the data analysis. The pooled RR of hypomagnesemia in patients with PPI use was 1.43 (95% CI, 1.08-1.88). The association between the use of PPIs and hypomagnesemia remained significant after the sensitivity analysis including only studies with high quality score (Newcastle-Ottawa scale score ≥ 8) with a pooled RR of 1.63 (95% CI, 1.14-2.23).
  
  
  CONCLUSIONS
  Our study demonstrates a statistically significant increased risk of hypomagnesemia in patients with PPI use. The finding of this meta-analysis of observational studies suggests that PPI use is associated with hypomagnesemia and may impact clinical management of patients who are taking PPIs and at risk for hypomagnesemia related cardiovascular events.
authors.affiliation: a Division of Nephrology and Hypertension , Mayo Clinic , Rochester , MN , USA .
authors.forename: Wisit
authors.initials: W
authors.lastname: Cheungpasitporn
authors.affiliation: a Division of Nephrology and Hypertension , Mayo Clinic , Rochester , MN , USA .
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: a Division of Nephrology and Hypertension , Mayo Clinic , Rochester , MN , USA .
authors.forename: Wonngarm
authors.initials: W
authors.lastname: Kittanamongkolchai
authors.affiliation: b Division of Pulmonary and Critical Care Medicine , Mayo Clinic , Rochester , MN , USA .
authors.forename: Narat
authors.initials: N
authors.lastname: Srivali
authors.affiliation: c Department of Medicine , SUNY Upstate Medical University , Syracuse , NY , USA .
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Edmonds
authors.affiliation: d Division of Rheumatology , Mayo Clinic , Rochester , MN , USA .
authors.forename: Patompong
authors.initials: P
authors.lastname: Ungprasert
authors.affiliation: e Department of Medicine , University College Cork , Cork , Ireland , and.
authors.forename: Oisin A
authors.initials: OA
authors.lastname: O'Corragain
authors.affiliation: f Department of Medicine , MetroWest Medical Center , Framingham , MA , USA.
authors.forename: Sira
authors.initials: S
authors.lastname: Korpaisarn
authors.affiliation: a Division of Nephrology and Hypertension , Mayo Clinic , Rochester , MN , USA .
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Erickson
mesh_terms: D006801:Humans; D008274:Magnesium / Q000097:blood*; D064887:Observational Studies as Topic; D016017:Odds Ratio; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D017594:Publication Bias
chemical_list: D054328:Proton Pump Inhibitors; D008274:Magnesium
keywords: Electrolyte; hypomagnesemia; magnesium; meta-analysis; proton pump inhibitors