Proton pump inhibitors (PPIs), long thought to be safe, are associated with a number of nonkidney adverse health outcomes and several untoward kidney outcomes, including hypomagnesemia, acute kidney injury, acute interstitial nephritis, incident chronic kidney disease, kidney disease progression, kidney failure, and increased risk for all-cause mortality and mortality due to chronic kidney disease. PPIs are abundantly prescribed, rarely deprescribed, and frequently purchased over the counter. They are frequently used without medical indication, and when medically indicated, they are often used for much longer than needed. In this In Practice review, we summarize evidence linking PPI use with adverse events in general and adverse kidney outcomes in particular. We review the literature on the association of PPI use and risk for hypomagnesemia, acute kidney injury, acute interstitial nephritis, incident chronic kidney disease, kidney disease progression, end-stage kidney disease, and death. We provide an assessment of how this evidence should inform clinical practice. We review the impact of this evidence on patients’ perception of risk, synthesize PPI deprescription literature, and provide our recommendations on how to approach PPI use and deprescription.

长期以来被认为是安全的质子泵抑制剂（PPI）与许多非肾脏不良健康结局和一些不良的肾脏结局相关，包括低镁血症，急性肾损伤，急性间质性肾炎，慢性肾脏病，肾脏疾病进展，肾脏失败，以及因慢性肾脏病导致的全因死亡率和死亡率增加的风险。PPI的处方非常丰富，很少被取消处方，并且经常在柜台上购买。它们经常在没有医学指征的情况下使用，并且在医学上有指征时，它们的使用时间通常比需要的更长。在本实践审查中，我们总结了将PPI的使用与一般的不良事件，尤其是不良的肾脏结局联系起来的证据。我们回顾了有关PPI使用与低镁血症风险之间关系的文献，急性肾脏损伤，急性间质性肾炎，慢性肾脏疾病，肾脏疾病进展，终末期肾脏疾病和死亡。我们提供了该证据应如何指导临床实践的评估。我们回顾了这些证据对患者风险感知的影响，综合了PPI处方说明，并就如何使用PPI和处方说明提供了建议。