Do Heartburn Drugs Cause Kidney Disease?

Is it true that Proton-Pump Inhibitors for heartburn and acid reflux can lead to kidney disease? If so, how great is the risk and what are people like me who depend on these drugs supposed to do?

– April 29, 2016

Proton Pump Inhibitors (PPIs) block the secretion of stomach acid. They are used to 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.

A large 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, other kidney problems and, possibly, heart problems among people who take PPIs. 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. Chronic kidney disease means the kidneys are damaged and unable to filter blood as they should, causing wastes to build up in the body.

The new 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.

In an editorial accompanying publication of the study, Adam Schoenfeld M.D. and Deborah Grady M.D. of the University of California, San Francisco, wrote that mounting evidence demonstrates that PPIs are associated with a number of adverse effects and are overprescribed. The study authors also noted that between 25 percent and 70 percent of prescriptions written for the drugs in the U.S. are not for appropriate medical indications.

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 of 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. Starting with the lowest effective dose is generally the best course. Instead of using these drugs long-term, I urge you to make lifestyle changes that can help eliminate the need for medication altogether. Instead of using these drugs long-term, I urge you to make lifestyle changes 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

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