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Abstract: FR-PO290

Association of Proton-Pump Inhibitor Use and Immune Checkpoint Inhibitor-Associated AKI: Evidence from a Meta-Analysis

Session Information

Category: Onconephrology

  • 1700 Onconephrology


  • Mohan, Arjunmohan, Nazareth Hospital, Philadelphia, Pennsylvania, United States
  • Krisanapan, Pajaree, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Tangpanithandee, Supawit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Herrmann, Sandra, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Group or Team Name

  • Mayo Clinic Rochester.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but their use is associated with immune-related adverse events (irAEs), including kidney injury. Proton pump inhibitors (PPI) are commonly prescribed medications independently associated with kidney injury. Understanding the relationship between ICI-associated acute kidney injury (ICI-AKI) and PPI use is crucial for optimizing patient management and minimizing complications.


To explore the association between ICI-AKI and PPI use, a comprehensive literature review was conducted. Databases including MEDLINE and EMBASE were systematically searched for articles published until January 2023. Studies reporting the incidence and risk of ICI-AKI in patients receiving ICIs, with or without concomitant PPIs, were identified and included in our analysis. Pooled odds ratios (ORs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird.


A total of 13 studies, involving 9371 patients, were included. The overall incidence of AKI from all-cause was 51.0% (95%CI, 32.9-68.9%) among patients on PPIs and 49.0% (95%CI, 31.1-67.1%) among those not on PPIs. Focusing specifically on ICI-AKI, the incidence was 59.0% (95%CI, 49.9-67.4%) among patients on PPIs, compared to 38.7% (95%CI, 30.7-47.4%) in those not on PPIs. Importantly, our analysis revealed a significant association between PPI use and the risk of ICI-AKI, with a pooled OR of 2.51 (95% CI 1.24-5.11). These findings indicate a higher likelihood of developing ICI-AKI when using PPIs.


In conclusion, our meta-analysis provides further evidence of an increased risk of ICI-AKI associated with the use of PPIs. Clinicians should exercise caution and try to avoid prescribing PPIs in patients undergoing ICI therapy, as these medications may potentially incite renal irAEs.