Nexium, Other PPIs and the Risk of Kidney Side Effects

Nexium, Prilosec and Prevacid are part of a class of medications known as proton pump inhibitors (PPIs). They are used to relieve heartburn and acid reflux by lowering the amount of acid produced by the stomach. Recent studies suggest that the long-term use of PPIs may be associated with an increased risk of kidney disease. These findings do not prove that PPIs cause kidney damage, but researchers believe that they highlight the need to use PPIs only when medically necessary in order to avoid potential side effects.

In January, a study published in JAMA Internal Medicine found that PPI use was associated with a 20 to 50 percent increased risk of kidney disease compared to non-users. The lead author was Dr. Morgan Grams, an assistant professor of epidemiology at Johns Hopkins University in Baltimore. Researchers analyzed data from a national survey of 10,000 people participating in a study on hardening of the arteries, and they looked at outpatient PPI prescriptions among 250,000 patients in a Pennsylvania health care system.

In both data groups, the use of PPIs was linked to a higher risk of chronic kidney disease over 10 years. Compared to those who did not use PPIs, using drugs such as Nexium, Prevacid or Prilosec was linked to a 20 to 50 percent increased risk. Higher doses were also associated with an elevated risk. A twice daily dose was linked to a 46 percent increased risk while a once-daily dose was associated with a 15 percent increased risk.

Another study, published in April in the American Society of Nephrology, found that PPI usage was associated with an increased risk of kidney disease. The researchers compared 170,000 new PPI users to 20,000 new users of H2 receptor blockers, another class of medications used to reduce stomach acid. In the H2 blocker group, the rate of chronic kidney disease was 11 percent compared to 15 percent in the PPI group. After adjusting for other factors, this results in a 28 percent increased risk of chronic kidney disease associated with PPI use. The risk of end-stage renal failure was 96 percent higher with PPI use, although it occurred in only a handful of patients.

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