Proton pump inhibitors – a popular type of acid reflux or heartburn medication – may lead to long-term kidney damage, warned a new study.
Those who use PPIs ran a 20 to 50 percent higher risk of chronic kidney disease than non-users, according to a team of researchers at Johns Hopkins University.
Drugs such as Prilosec, Nexium, and Prevacid belong to this class of drugs, treating heartburn and acid reflux – also known as gastroesophageal reflux disease (GERD) – through reducing the amount of stomach acid. Acid reflux is characterized by food or liquid moving up from the stomach to the esophagus, potentially damaging the lower part of the esophageal tube.
Epidemiologist and lead researcher Morgan Grams said PPPs are highly common medications.
“Given the fact that so many people use PPI medications, I think it is judicious to exercise some caution,” Grams said.
The team examined the link of PPIs to chronic kidney disease, examining the medical data of two segments: over 10,400 participants of the Artherosclerosis Risk in Communities (ARIC) study, and nearly 250,000 patients of Pennsylvania’s Geisinger Health System.
Of the 322 subjects using PPIs in the ARIC research, there was an 11.8 percent estimated absolute risk for chronic kidney disease within 10 years. It exceeded the expected risk of 8.5 percent.
The 10-year absolute risk for 16,900 patients taking PPIs in the second group was 15.6 percent – again exceeding the expected 13.9 percent.
The team also compared people taking PPIs once a day with those medicating twice daily. The finding: twice-daily users had a 46 percent higher risk for chronic kidney disease compared to the 15 percent of once-daily users.
According to Dr. Grams, the study won't determine those at the highest risk for kidney disease, as it only looked at who received a PPI prescription and not the duration of drug intake. It also does not prove that PPIs directly cause chronic kidney disease – a relationship that needs to be further probed.
Dr. Kenneth DeVault, American College of Gastroenterology president, echoed that some skepticism may be necessary, given this new study is not a clinical trial and does not show direct causation. He explained that the PPI users often suffer chronic kidney disease due to a generally poor state of health.
When these drugs were first approved in the 1980s, they appeared to be very safe. Yet safety issues ensued, showing evidence that they may heighten the risk for medical problems such as infections, bone fractures, and even heart disease.
Gastroenterologists have also sounded the alarm on using PPIs due to other health problems tied to them. "We have started to limit the time you have to be on it, and limit the amount you take," said Dr. Arun Swaminath, inflammatory bowel disease program director at New York City’s Lenox Hill Hospital in New York City.
Both Drs. Grams and DeVault encouraged people on PPIs to regularly consult their doctor and assess their need for the medication. Dr. Swaminath added that physicians may also choose to instead prescribe H2 blockers such as Pepcid or Zantac.
Dr. Adam Schoenfeld, an internal medicine resident at UC San Francisco, urged against the inappropriate use of PPI prescriptions and favored other measures for treating heartburn and indigestion, including dietary changes or reduced alcohol intake.
The team published their findings Jan. 11 in the journal JAMA Internal Medicine.
Photo: Rennett Stowe | Flickr