Research Suggests Long-Term PPI Use is Linked to Kidney Damage

Two studies published this year evaluated the risk of kidney damage associated with proton pump inhibitors (PPIs). PPIs, which treat heartburn and acid reflux by lowering the amount of stomach acid produced, include Prilosec, Nexium and Prevacid. The studies suggest that long-term use of PPIs may be associated with an increased risk of chronic kidney disease. The findings underscore the need for caution when taking Prilosec, Nexium or Prevacid. Study authors say PPI use should be limited to situations that are medically necessary.

JAMA Internal Medicine published a study linking PPIs to an increased risk of chronic kidney disease in January. Dr. Morgan Grams, an assistant professor of epidemiology at Johns Hopkins University in Baltimore, led the study. She and her colleagues used two different data sources to study the rate of chronic kidney disease among PPI users. They 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 groups, PPI users showed an increased risk of chronic kidney disease over 10 years. Patients taking PPIs were 20 to 50 percent more likely to experience chronic kidney disease compared to those who did not. The risk appeared to be greater among those who took the drug more frequently; 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, drew similar conclusions. Researchers compared 170,000 new PPI users to 20,000 new users of H2 receptors blockers, another class of medications used to reduce stomach acid. The rate of chronic kidney disease in the H2 blocker group 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. Only a few patients in the study actually developed end-stage renal failure, although the risk was 96 percent higher with PPI use.

In both studies, the findings do not prove that PPIs caused kidney damage. They only indicate an association between PPI use and chronic kidney disease. Researchers and experts do believe, however, that the findings highlight the need to use Prilosec, Nexium and Prevacid only when warranted. Study author Dr. Ziyad Al-Aly of the Clinical Epidemiology Center at the VA Saint Louis Health Care System, told CBS News “[patients should] use PPIs only when it is medically necessary, and should limit duration of exposure to the minimum necessary to treat the underlying medical condition,”

Dr. Kenneth R. DeVault, president of the American College of Gastroenterology and chair of medicine at Mayo Clinic in Jacksonville, told CBS News that patients can make certain lifestyle changes to mitigate heartburn symptoms. These steps include: losing weight, avoiding high fat foods, avoid eating late at night and elevating the head of the bed on six to eight inch blocks.

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