PPI Use in Dialysis Patients

Pharmacokinetics and Dosing

Standard once-daily dosing (omeprazole 20mg or pantoprazole 40mg) is appropriate for most indications, according to the American College of Gastroenterology 1

PPIs are strongly recommended for portal hypertensive bleeding in critically ill patients, including those with acute-on-chronic liver failure who may also have renal failure, by the Society of Critical Care Medicine 2
PPIs reduce rebleeding rates and need for repeat intervention by raising gastric pH and stabilizing fibrin clots in patients with portal hypertensive bleeding, as recommended by the Society of Critical Care Medicine 2
Standard once-daily dosing is equivalent to high-dose regimens for preventing rebleeding after source control, according to the American College of Gastroenterology 1

Portal hypertensive bleeding, documented peptic ulcer disease, or severe GERD refractory to other measures warrant PPI use, as indicated by the Society of Critical Care Medicine 2
Start with once-daily standard dosing (omeprazole 20mg or pantoprazole 40mg) and limit duration to 4-8 weeks for acute indications, then reassess, as recommended by the American College of Gastroenterology 1