Association Between Proton Pump Inhibitor Exposure and Acute Kidney Injury After Cardiac Surgery

Hee Byung Koh, Young Su Joo, Hyung Woo Kim, Wonji Jo, Shin Chan Kang, Jong Hyun Jhee, Minkyung Han, Myeongjee Lee, Seung Hyeok Han, Tae Hyun Yoo, Shin Wook Kang, Jung Tak Park

Research output: Contribution to journalArticlepeer-review


Objective: To evaluate the association of preoperative proton pump inhibitor (PPI) exposure with incident acute kidney injury (AKI) after cardiac surgery. Patients and Methods: The Severance cardiac surgery cohort included 9860 cardiac surgery patients aged 18 years or older. The National Health Insurance Service-senior cohort included 2933 patients aged 60 years or older who underwent cardiac surgery. Preoperative PPI exposure was defined as a PPI prescription within 3 weeks prior to cardiac surgery. Primary outcomes were postoperative AKI and AKI requiring dialysis (AKI-dialysis). Results: In the Severance cardiac surgery cohort after propensity score matching for PPI exposure, incident AKI (44.0% [472 of 1073] vs 40.5% [1304 of 3219]) and AKI-dialysis (5.8% [62 of 1073] vs 3.7% [119 of 3219]) were more common in patients exposed to PPI than in those who were not. Hospital and intensive care unit stay durations were longer among PPI-exposed than PPI-nonexposed patients. Multivariable conditional logistic analyses revealed that PPI exposure was significantly associated with incident AKI (adjusted odds ratio [AOR], 1.21; 95% CI, 1.03 to 1.42; P=.02) and AKI-dialysis (AOR, 1.74; 95% CI, 1.15 to 2.63; P=.009). The National Health Insurance Service–Senior cohort had similar results, revealing a significant association between PPI exposure and incident AKI-dialysis (AOR, 1.87; 95% CI, 1.25 to 2.81; P=.003). Discontinuation of PPI prior to operation was associated with a lower odds of AKI development in both cohorts. Conclusion: Preoperative PPI exposure may be a modifiable risk factor for AKI among patients undergoing cardiac surgery.

Original languageEnglish
Pages (from-to)266-277
Number of pages12
JournalMayo Clinic Proceedings
Issue number2
Publication statusPublished - 2023 Feb

Bibliographical note

Funding Information:
Data Sharing Statement: Study protocol—Available upon request; Statistical code—Statistical codes used for analyses are available from Dr Park ( Data set—Severance cardiac surgery cohort data are not publicly available because the ownership belongs to Yonsei University Health System but would be considered upon reasonable request. NHIS-Senior cohort data are available via the Korean National Health Insurance Sharing Service. Researchers can request access through website application at, Author Contributions: Dr Koh—Conceptualization, methodology, software, formal analysis, data curation, writing/original draft; Dr Joo—Methodology, software, formal analysis, data curation; Dr Kim—Software, formal analysis, data curation; Dr Jo—Conceptualization, methodology, data curation; Dr S. C. Kang—Conceptualization, software, formal analysis; Dr Jhee—Formal analysis, data curation; Dr M. Han—Methodology, software, formal analysis, supervision, writing/review and editing; Dr Lee—Methodology, software, formal analysis, supervision, writing/review and editing; Dr S. H. Han—Conceptualization, supervision, writing/review and editing; Dr Yoo—Conceptualization, supervision, writing/review and editing; Dr S.-W. Kang—Conceptualization, supervision, writing/review and editing; Dr Park—Conceptualization, methodology, supervision, writing/original draft, writing/review and editing.

Publisher Copyright:
© 2022 Mayo Foundation for Medical Education and Research

All Science Journal Classification (ASJC) codes

  • Medicine(all)


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