CKD May Result from Proton Pump Inhibitors

This article caused me to ask my pharmacist some questions about the medication I was taking for acid reflux. She said that because of the gall bladder removal they were careful to give me an acid reflux medication that was not a proton pump inhibitor.

The article is this one and discusses that certain medications often used to treat heartburn and acid reflux may have damaging effects on the kidneys. The drugs, called proton pump inhibitors (PPIs), are among the top 10 class of prescribed medications in the United States.

With all the problems of chronic kidney disease (CKD) on the increase, apparently physicians are not properly assessing patients and keeping the patients on the medication for too long. Three studies indicate that PPIs may be contributing to the CKD epidemic.

In one study, Benjamin Lazarus, MBBS (Johns Hopkins University) and his colleagues followed 10,482 adults with normal kidney function from 1996 to 2011. They found that PPI users were between 20% and 50% more likely to develop CKD than non-PPI users, even after accounting for baseline differences between users and non-users. This discovery was replicated in a second study, in which over 240,000 patients were followed from 1997 to 2014. “In both studies, people who used a different class of medications to suppress stomach acid, known as H2-blockers, did not have a higher risk of developing kidney disease,” said Dr. Lazarus. “If we know the potential adverse effects of PPI medications we can design better interventions to reduce overuse.”

In the third study, Pradeep Arora, MD (SUNY, Buffalo) and his team found that among 24,149 patients who developed CKD between 2001 and 2008 (out of a total of 71,516 patients), 25.7% were treated with PPIs. Among the total group of patients, those who took PPIs were less likely to have vascular disease, cancer, diabetes, hypertension, and chronic obstructive pulmonary disease. However, PPI use was linked with a 10% increased risk of CKD and a 76% increased risk of dying prematurely.

“As a large number of patients are being treated with PPIs, health care providers need to be better educated about the potential side effects of these drugs, such as CKD,” said Dr. Arora. “PPIs are often prescribed outside of their approved uses, and it has been estimated that up to two-thirds of all people on PPIs do not have a verified indication for the drug.”

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The proton pump inhibitors include:

• Omeprazole (Prilosec), also available over-the-counter (without a prescription)
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Rabeprazole (AcipHex)
• Pantoprazole (Protonix)
• Dexlansoprazole (Kapidex)