Proton Pump Inhibitors (PPIs) block the secretion of stomach acid. They are used to help relieve heartburn and gastroesophageal reflux disease (GERD), in which stomach acid backs up into the esophagus. They also may be recommended for treatment of esophageal inflammation (esophagitis) and esophageal ulcers due to acid reflux as well as for gastric inflammation and ulceration. Nexium, Prilosec and Prevacid are three popular examples of PPIs. More than 15 million Americans use them. Originally prescription-only drugs, over-the-counter (OTC) forms are now available.
Within the past year, two large studies have suggested that PPIs appear to raise the risk of kidney disease. The latest, from Washington University School of Medicine in St. Louis, published in February 2017, found that more than half the patients who developed kidney disease while taking PPIs didn’t have typical symptoms. (These include too little urine leaving the body, fatigue, and swelling in the legs and ankles.) Instead, the study revealed a “silent” decline in kidney function that can lead to long-term kidney damage and even end-stage renal disease, when the kidneys no longer can function effectively to clear wastes from the body. Treatment requires dialysis or a kidney transplant.
The researchers analyzed data on 125,596 new users of PPIs from Department of Veterans Affairs databases as well as on new users of H2 blockers, another class of heartburn drugs less likely to cause kidney problems. Over five years of follow-up, they found that in more than half the cases of chronic kidney damage and end-stage renal disease linked to PPI use, users had no warning signs or symptoms. The drugs studied were prescription strength, not the lower-dose OTC forms. Because the study was observational, it showed only an association between taking the drugs and kidney problems, not cause and effect.
An earlier study, published in January 2016 in JAMA Internal Medicine, found that PPIs appear to raise the risk of chronic kidney disease. This isn’t the first time these drugs have been linked to serious health problems. Earlier studies have identified increased risks of bone fractures, vitamin B12 deficiency, pneumonia, C. difficile infection, and, possibly, heart problems associated with their use. The new kidney disease risk emerged from an examination of the medical records of more than 259,000 people. After examining data from 10,482 of the participants, the researchers, from Johns Hopkins, reported that the 10-year estimated absolute risk for kidney disease was 11.8 percent in those using PPIs, compared to an expected risk of 8.5 percent. They also found that the 10-year absolute risk among another 16,900 patients on PPIs was 15.6 percent, compared to an expected risk of 13.9 percent. The study doesn’t prove that the PPIs were the cause of the additional cases of chronic kidney disease seen, but the Hopkins researchers consider their findings troubling enough to warrant caution in the use of the drugs.
While PPIs work well on a temporary basis, I urge you to avoid long-term use. If you’ve been on one and have tried to stop it, you have probably experienced a “rebound” effect: your symptoms come back worse than ever. Because of this, it is very difficult to get off a PPI once you have been on it for more than a short period.
If you take one of these drugs, do so under the supervision of your physician. You also should be aware that there’s no discernible difference in effectiveness between the various PPIs available, and using the lowest effective dose is generally the most prudent and effective course of treatment. Instead of using these drugs long-term, I urge you to make lifestyle changes and try natural remedies that can help eliminate the need for medication altogether.
Andrew Weil, M.D.
Morgan E. Grams et al, “Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease.” JAMA Internal Medicine, January 11, 2016, doi:10.1001/jamainternmed.2015.7193
Ziyad Al-Aly et al, “Long-term kidney outcomes among users of proton pump inhibitors without intervening acute kidney injury.” Kidney International, February 2017 DOI: 10.1016/j.kint.2016.12.021
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