Proton Pump Inhibitors & Kidney Failure

Proton pump inhibitors (PPIs) are oral medications used to treat acid reflux and the conditions associated with it. Many heartburn and acid reflux medications are PPIs, including prescription versions sold under the brand names Nexium, Prilosec, and Prevacid.

PPIs are one of the most prescribed medications in the world with more than 15 million Americans using the drugs in 2013, but recent studies show use of these drugs – especially overuse – is associated with an increased risk for chronic kidney disease (CKD), also known as renal failure.

The newest developments come following two population-based analyses published in the January 2016 issue of JAMA Internal Medicine in which authors suggested PPIs could play a role in why CKD prevalence is rising faster than expected. The study was observational so there is no evidence of causality, but it still links PPI use with CKD and the information warrants further investigation.

Also of concern is the over and unnecessary use of the drugs. Studies showed that 70% of the prescriptions for PPIs were without indication and that about a quarter of long-term users could discontinue therapy without suffering any negative consequences. Some doctors believe dietary and lifestyle education could increase that number even further.

About the Analyses

The analyses included an examination of the medical records of patients from the JAMA study and showed those taking PPIs had an increased risk for CKD of 20 to 50 percent. Another study, presented at the American Society of Nephrology meeting in the fall of 2015, showed similar results. Both indicated the longer or more frequent the use of medication the greater the risk is for complications.

There were more than 10,000 patients evaluated in the studies and many were observed for up to 14 years.

Specific study results were as follows:

Among 10 482 participants in the Atherosclerosis Risk in Communities study, the mean (SD) age was 63.0 (5.6) years, and 43.9% were male. Compared with nonusers, PPI users were more often of white race, obese, and taking antihypertensive medication. Proton pump inhibitor use was associated with incident CKD in unadjusted analysis (hazard ratio [HR], 1.45; 95% CI, 1.11-1.90); in analysis adjusted for demographic, socioeconomic, and clinical variables (HR, 1.50; 95% CI, 1.14-1.96); and in analysis with PPI ever use modeled as a time-varying variable (adjusted HR, 1.35; 95% CI, 1.17-1.55). The association persisted when baseline PPI users were compared directly with H2 receptor antagonist users (adjusted HR, 1.39; 95% CI, 1.01-1.91) and with propensity score–matched nonusers (HR, 1.76; 95% CI, 1.13-2.74). In the Geisinger Health System replication cohort, PPI use was associated with CKD in all analyses, including a time-varying new-user design (adjusted HR, 1.24; 95% CI, 1.20-1.28). Twice-daily PPI dosing (adjusted HR, 1.46; 95% CI, 1.28-1.67) was associated with a higher risk than once-daily dosing (adjusted HR, 1.15; 95% CI, 1.09-1.21).

About CKD

Chronic kidney disease, or renal failure, is the gradual loss of kidney function. This means kidneys are no longer able to perform their natural function of filtering waste and excess fluids from the blood. Advanced stage CKD can result in dangerous levels of fluid, electrolytes and wastes can build up in your body.

Because the symptoms of kidney disease can be few at the earliest stages, many patients are not diagnosed until the disease has progressed to later stages.

Symptoms include:

  • Nausea, vomiting, and loss of appetite
  • Fatigue and weakness
  • Chronic itching
  • Muscle twitches and cramps
  • Insomnia and other sleeping problems
  • Changes in urine output
  • Decrease in mental clarity
  • Hiccups
  • Swelling in the feet and ankles
  • Fluid buildup that can result in chest pain or shortness of breath
  • Difficult-to-control hypertension

Treatment is focused on slowing the progression of kidney damage, often by controlling the underlying cause. End-stage kidney failure is considered fatal, unless a patient undergoes ongoing dialysis treatment or receives a kidney transplant.

Other Risks Associated with PPIs

In addition to CKD, there is also evidence PPI use could be related to:

  • Acute interstitial nephritis
  • Hypomagnesemia
  • Clostridium difficile infection
  • Community-acquired pneumonia
  • Osteoporotic fractures
  • Birth defects
  • Myocardial infarction

What You Can Do

If you or someone you love has been using PPIs and experienced adverse effects, including CKD or other kidney problems, you might be entitled to compensation. Speak with your doctor before starting or stopping usage of any medications.

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