Early postoperative administration of proton pump inhibitors and acute kidney injury after cardiac surgery

Q: What are the key findings of this study?

Early postoperative PPI administration was associated with higher rates of postoperative AKI (88.94% vs 83.88%, p=0.002) and severe AKI (64.71% vs 58.82%, p=0.013) after cardiac surgery.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute kidney injury after cardiac surgery (n=6559). Intervention: Early postoperative proton pump inhibitor (PPI) administration vs. No early postoperative PPI administration. Primary outcome: Postoperative acute kidney injury (AKI) (p=0.002).

Q: What does this research mean for the field?

Early postoperative proton pump inhibitor administration is associated with a significantly increased risk of acute kidney injury and severe acute kidney injury after cardiac surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

R An; B Wang; F Yan

doi:10.1093/eurheartj/ehag785.2040

October 1, 2026European Heart Journal

Early postoperative administration of proton pump inhibitors and acute kidney injury after cardiac surgery

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Key result

Early postoperative PPI use is linked to ~5 percentage points higher AKI risk after cardiac surgery.

P=0.002
n=6,559

Why the study?

The effect of early postoperative proton pump inhibitor administration on acute kidney injury after cardiac surgery needed to be explored.

Does early postoperative proton pump inhibitor administration increase the risk of acute kidney injury in patients undergoing cardiac surgery?

Key Points

To investigate the association between early postoperative proton pump inhibitor administration and the incidence of acute kidney injury following cardiac surgery.
Extracted clinical data from the Medical Information Mart for Intensive Care IV database on 6,559 cardiac surgery patients, divided into an early postoperative proton pump inhibitor group (n=5,667) and a non-user group (n=892).
Constructed a 1:1 propensity score-matched cohort (n=850 per group) to balance baseline covariates.
Assessed associations using multivariable logistic regression, propensity score matching, and inverse probability of treatment weighting models, alongside subgroup and interaction analyses.
Propensity score-matched analysis revealed significantly higher incidences of acute kidney injury (88.94% vs. 83.88%, p = 0.002) and severe acute kidney injury (64.71% vs. 58.82%, p = 0.013) in the proton pump inhibitor group compared with the non-user group.
Proton pump inhibitor administration was associated with significantly longer intensive care unit stays (3.32 vs. 2.22 days, p < 0.001) and hospital stays (9.96 vs. 8.27 days, p < 0.001), with no significant difference in postoperative mortality.
Multivariable logistic regression, propensity score matching, and inverse probability weighting consistently linked early proton pump inhibitor use to increased kidney injury risk, with no significant interaction across stratified subgroups.

Study Design

Type

Cohort (n=6,559)

Structured PICO

Does early postoperative proton pump inhibitor administration increase the risk of acute kidney injury in patients undergoing cardiac surgery?

P

Population

6,559 patients undergoing cardiac surgery from the MIMIC-IV database (1,700 after 1:1 propensity score matching) evaluated for postoperative acute kidney injury.

E

Exposure

Early postoperative proton pump inhibitor (PPI) administration (n=5,667 before PSM; n=850 after PSM)

C

Comparator

No proton pump inhibitor (non-PPI) administration in the early postoperative period (n=892 before PSM; n=850 after PSM)

O

Outcome

Incidence of postoperative acute kidney injury (AKI)hard clinical

Main Result

Absolute Event Rate: 88.94% vs 83.88%

p-value: p=0.002

Early postoperative administration of proton pump inhibitors in cardiac surgery patients is significantly associated with higher rates of acute kidney injury, severe acute kidney injury, and prolonged ICU and hospital stays, suggesting it may be a modifiable perioperative risk factor.

Implication

May warrant caution with early PPI use after cardiac surgery; leaves open causality and need for randomized confirmation.

Abstract

Aims This study aimed to explore the effect of early postoperative proton pump inhibitors (PPI) administration on acute kidney injury (AKI) after cardiac surgery. Methods This study retrieved data on patients undergoing cardiac surgery from the Medical Information Mart for Intensive Care IV database. All patients were divided into the non-PPI group and PPI group according to whether they used PPI in the early postoperative period. The incidence of postoperative AKI, severe AKI (SAKI), length of intensive care unit stay (LOIS), length of hospital stay (LOHS), and postoperative mortality were compared between the two groups before and after propensity score matching (PSM). Then, the univariate logistic regression, multivariate logistic regression, PSM, and inverse probability of treatment weighting (IPTW) were performed respectively to evaluate the association between early postoperative PPI administration and AKI. Finally, subgroup and interaction analyses were performed to assess the interactions between early postoperative PPI administration and stratification variables. Results A total of 6559 patients were included in this study. 5667 (86.40%) patients used PPI, and 892 (13.60%) patients did not use PPI in the early postoperative period. After 1:1 PSM, there were 850 patients in each group of non-PPI and PPI with good balance. The incidence of postoperative AKI (88.94% vs. 83.88%, p = 0.002) and SAKI (64.71% vs. 58.82%, p = 0.013) in the PPI group was significantly higher than that in the non-PPI group. The LOIS (3.32 vs. 2.22, p < 0.001) and LOHS (9.96 vs. 8.27, p < 0.001) were significantly prolonged in the PPI group. The two groups had no significant difference in postoperative mortality. Early postoperative PPI administration was significantly associated with an increased risk of postoperative AKI and SAKI across univariate logistic regression, multivariate logistic regression, PSM and IPTW models. There was no interaction between early postoperative PPI administration and stratification variables. Conclusions Early postoperative PPI administration significantly increased the risk of postoperative AKI and SAKI and prolonged the LOIS and LOHS in cardiac surgery patients. Early postoperative PPI administration may be a modifiable perioperative risk factor for AKI after cardiac surgery.

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Cite This Study

An et al. (2026) conducted a cohort in Acute kidney injury after cardiac surgery (n=6,559). Early postoperative proton pump inhibitor (PPI) administration vs. No early postoperative PPI administration was evaluated on Postoperative acute kidney injury (AKI) (p=0.002). Early postoperative PPI administration was associated with higher rates of postoperative AKI (88.94% vs 83.88%, p=0.002) and severe AKI (64.71% vs 58.82%, p=0.013) after cardiac surgery.

synapsesocial.com/papers/6adf47809811dd2590be9dc3 https://doi.org/10.1093/eurheartj/ehag785.2040

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Early postoperative administration of proton pump inhibitors and acute kidney injury after cardiac surgery

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

Early postoperative administration of proton pump inhibitors and acute kidney injury after cardiac surgery

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

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