Hundreds of thousands of new users of PPIs (without kidney disease) examined in the Department of Veterans Affairs (VA) were found to be 30 percent more likely to develop chronic kidney disease over the course of five years of using PPIs. Risk of kidney failure doubled for these patients.
Nexium, Prevacid, Prilosec, Protonix, Aciphex
PPIs like Nexium and Protonix are prescribed to treat ulcers, so-called “heartburn,” and acid reflux. Authors of the study, published in the Journal of the American Society of Nephrology, said that these drugs are generally considered safe, but noted they may be overprescribed and continued for longer periods than necessary.
PPI Drugs vs. H2 Blockers
Senior author Dr. Ziyad Al-Aly, associate chief of staff for research and education at the VA Saint Louis Health Care System, said, “We suggest judicious use of PPI, and that use be limited to when it is medically necessary and to the shortest duration possible.”
Study authors analyzed data in national VA databases covering 20,270 new users of PPIs. They compared these people to 173,321 others who had begun H2 blockers, which reduce stomach acid by a different mechanism; H2s block histamines in the stomach.
No patients had kidney problems at the start. They were followed for five years to monitor their kidney function.
After adjusting for personal, social, economic factors and health conditions that could impact kidney disease risk, the study found PPI users at significantly higher risk of new kidney problems compared to H2 blocker users.
People taking PPIs faced a risk of a decline in kidney function 32 percent higher, while the risk of new cases of chronic kidney disease was 28 percent higher.
PPIs and Renal Disease
People taking PPIs were 96 percent more likely to experience end-stage renal disease – kidney failure – than those who took H2 blockers. The risks also increased over time with PPIs, stabilizing after some two years.
PPI Problems and OTC Use
Dr. Al-Aly said that because many PPIs are available over the counter (OTC), people may take them without doctor guidance. He recommends limiting the use of OTC PPIs. He told Reuters Health that he recommends that people who frequently take OTC PPIs consult their doctors to determine the best and safest options.
H2 Blockers less likely to cause kidney problems
Dr. David Juurlink, a clinical pharmacologist and drug safety researcher at the University of Toronto, told Reuters by email that H2 blockers are much less likely to cause kidney problems but are often not as effective as PPIs.
Dr. Juurlink said, “For many patients, dietary modification (less fat and alcohol) would make acid-lowering drugs unnecessary and would impart other long-term benefits as well.”
Heartburn drugs double risk of kidney problems
Dr. Juurlink also pointed out that PPIs carry risks like all drugs, and that just because a drug is available OTC doesn’t mean it’s safe. He advised that PPI users who develop kidney problems ask their doctors whether the drugs might be a factor.