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Doctors Deny That PPIs Can Cause Kidney Damage

PPIs (proton pump inhibitors) are great at suppressing acid, relieving heartburn and healing ulcers. But evidence suggests PPIs can cause kidney damage.
Doctors Deny That PPIs Can Cause Kidney Damage
Female hand holding model of human kidney organ at back of body

It can take years or even decades to discover serious drug side effects. Think of it as a long-running drug experiment. Proton pump inhibitors like esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec) are among the more popular pills in the pharmacy. People take them for heartburn as well as to help heal ulcers. Doctors often prescribe PPIs such as omeprazole or lansoprazole to hospitalized patients to prevent something called stress ulcers. In addition, these drugs were considered so safe the FDA approved nonprescription status. Now reports are surfacing that PPIs can cause kidney damage.

Korean Study Shows PPIs Can Cause Kidney Damage:

Data from nearly 10,000 Korean patients undergoing cardiac surgery suggests that PPIs could be risky for people undergoing cardiac surgery (ASN Kidney Week 2021). More than 5 percent of the patients who were taking PPIs prior to surgery developed acute kidney injury that necessitated dialysis during their hospitalization. In contrast, about 3 percent of those not taking PPIs experienced that type of kidney complication. Kidney-related deaths in the hospital were also higher among those taking PPIs. The authors suggest it would be prudent for people to stop taking their PPI before entering the hospital for cardiac surgery.

Previous Studies Also Showed That PPIs Might Harm Kidneys:

This link is not really new. When previous research suggested it several years ago, we thought the FDA would be embarrassed. Such news also aggravates some doctors. Many people want to know whether a different class of heartburn medicine (H2-blockers or H2-receptor antagonists) would be safer.

One reader wrote:

Q. You wrote that PPI drugs for acid reflux can put a person at risk for kidney disease. That happened to me.

I quit taking the PPI upon learning that I had stage 3 kidney disease, and my kidney function is holding steady now. Changing from the PPI was a fairly easy process. I went to Zantac, and it works well in controlling my GERD. Why does anyone take these PPI medicines? They can be so detrimental to health.

A. GERD or gastroesophageal reflux disease is not only unpleasant; it can also lead to changes in the lining of the esophagus. Before proton pump inhibitors (PPIs) like esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec), doctors prescribed H2 blockers such as cimetidine (Tagamet), famotidine (Pepcid) or ranitidine (Zantac). Ranitidine is no longer available for other reasons.

H2 blockers work reasonably well to control chronic heartburn without damaging the kidneys (Scientific Reports, Feb. 19, 2019).

Some Doctors Deny that PPIs Can Cause Kidney Damage:

Ronnie in Texas shared this story about his kidney specialist:

“My nephrologist says that he doesn’t believe that the PPIs are responsible for kidney disease. He says that the studies don’t take any other factors into consideration.

“In my case, he believes that my kidney disease was caused by the large doses of NSAIDS that I took because of the muscle and joint pain caused by statins. I have been taking Nexium for over 20 years, and my kidney numbers are getting better with every test.”

Ronnie, we are delighted to learn that your kidney function is improving. Your nephrologist is absolutely right that large doses of NSAIDs like diclofenac, ibuprofen or naproxen can damage the kidneys.

Sometimes people take PPIs to try to protect the digestive tract from the ravages of NSAIDs. We wonder whether this would present a double whammy to the kidneys.

Should People Be Concerned if PPIs Can Cause Kidney Damage?

Your nephrologist may be right about NSAIDs being the culprits in your case. There is, however, growing evidence to suggest that PPIs can cause kidney damage.

The article in Scientific Reports (Feb. 19, 2019) notes:

“Recently, PPI use has come under scrutiny due to growing evidence of renal, cardiovascular, autoimmune and neurologic adverse effects. New data has revealed associations with myocardial infarction,, Clostridium difficile-associated diarrhea, community acquired pneumonia, bone fractures, subacute cutaneous lupus erythematosus, Alzheimer’s dementia, and kidney injury. Here we evaluated the frequencies of reported adverse events related to kidney injury and electrolyte disturbances in patients taking PPIs.”


“In this study of over ten million FDA Adverse Event Reporting System records, we provided evidence of kidney injury and electrolyte imbalances in an alarming number of patients taking PPIs. Additionally, we assessed differences between specific PPIs and observed significant electrolyte and renal abnormalities for each individual drug with varying magnitudes.”

The authors recommend to their colleagues that:

“It may be beneficial to monitor renal function and electrolytes including potassium, calcium, magnesium, and sodium. Although H2RAs [histamine-2 receptor antagonists ] have not been shown to be as effective as PPIs, they might be considered as alternatives for patients who are at high risk for developing renal and electrolytes imbalances.”

Histamine H2-receptor antagonists (aka H2-blockers) include:

  • Cimetidine (Tagamet)
  • Famotidine (Pepcid)
  • Nizatidine (Axid)
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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
  • Koh HB et al, "Proton Pump Inhibitor Exposure and Risk of Acute Kidney Injury after Cardiac Surgery.” ASN Kidney Week 2021
  • Makunts, T., et al. “Analysis of postmarketing safety data for proton-pump inhibitors reveals increased propensity for renal injury, electrolyte abnormalities, and nephrolithiasis,” Scientific Reports, Feb. 19, 2019, doi: 10.1038/s41598-019-39335-7.
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