Background:Currently, the interaction between proton pump inhibitors (PPI) and their effects on hemodialysis (HD) patients has not been clarified. Here, we aimed to explore the association between PPI and adverse outcomes in HD patients. Methods:A search was performed on the PubMed, Embase, Cochrane Library, and Web of Science databases for relevant articles published up to April 10, 2022. Studies examining the association (odds ratio [OR]) between PPI and side effects were identified. The study followed guidelines prescribed in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and was registered with PROSPERO (CRD42021291177). Results: A total of 12 studies comprising 4,227,497 HD patients with PPI were identified. Results showed that PPI use was associated with increased risk of bone fracture and hip fracture in the HD patients (pooled OR = 1.29, 95% CI = 1.21-1.37, p
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