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More Bad News About PPIs and Kidney Damage

PPIs for acid reflux have been linked to infections, heart attacks, strokes, nutritional deficiencies and osteoporosis. What about PPIs and kidney damage?

The FDA loves proton pump inhibitors (PPI)s. So do doctors, especially gastroenterologists. Drugs like esomeprazole (Nexium) lansoprazole (Prevacid) and omeprazole (Prilosec) used to top the doctors’ hit parade of most prescribed drugs. Then the FDA decided that these powerful acid-suppressing medications were so wonderful and so safe they should be made available without a prescription. But a new study adds to the growing data that there is a link between PPIs and kidney damage.

Comparing PPIs to H2 Blockers:

There has been a lot of push back from health professionals when it comes to questions about PPI complications. Gastroenterologists love proton pump inhibitors because they heal ulcers quite effectively. They also help overcome symptoms of GERD (gastroesophageal reflux disease) such as esophagitis.

It is hard to grapple with research suggesting that such drugs can have serious consequences. And it has been our experience that the FDA gets uncomfortable when a class of drugs it has approved for OTC sale turns out to have serious side effects.

We have heard on more than once occasion that people who have reflux could be more likely to experience other health problems. They could be overweight, have a hiatal hernia or eat unhealthy food. That is why the latest study published in Scientific Reports (Feb. 19, 2019) was so interesting.

Linking PPIs and Kidney Damage:

A data mining initiative of the FDA’s Adverse Event Reporting System (FAERS) analyzed kidney-related side effects among 42,537 people who took PPIs. Approximately 8,300 people taking a histamine-2 blocker such as ranitidine (Zantac) or famotidine (Pepcid) served as controls, since they take these drugs for similar symptoms.

The researchers found that 5.6 percent of people on PPIs alone had a kidney-related side effect, while only 0.7 percent of those on H-2 blockers did. Chronic kidney disease was 28 times more likely and acute kidney injury was 4 times more likely among people taking PPIs. Some PPIs appeared far worse than others. This might have been related to the popularity of some PPIs over others. Remember, this analysis was based on adverse reports submitted to the FDA.

The Association between PPIs and Kidney Damage:

The authors reported the following kidney problems associated with PPIs:

  • Acute Kidney Injury
  • Chronic Kidney Disease
  • End Stage Kidney Disease
  • Kidney Stones (Nephrolithiasis)
  • Electrolyte Disturbances (low magnesium levels)

The authors were surprised to discover an association between PPI exposure and an:

“…unexpected significant risk for nephrolithiasis and renal impairment.”

In other words, they did not anticipate PPIs would be linked to kidney stones.

While this analysis shows association, not causation, there are previous studies linking PPIs and kidney damage. You may find these articles of interest if you would like to learn more about PPIs and kidney damage:

Should You Worry About Kidney Damage with PPI Heartburn Drugs?

Can PPI Heartburn Drugs Harm Kidneys Without Early Symptoms?

The authors or the latest study regarding PPIs and kidney damage conclude:

“The observed increased risks of renal and electrolyte adverse effects of PPIs warrant more careful consideration in clinical practice. The risk-benefit ratio should be considered for the individual patient with respect to the adverse effects. When clinically indicated, PPIs should be used for the shortest duration necessary and chronic use is not recommended except for treatment of pathological hypersecretory conditions including Zollinger-Ellison syndrome and maintenance healing of erosive esophagitis.”

They also note that OTC use of proton pump inhibitors pose a potential risk as well:

“…over-the-counter use of PPIs for the treatment of gastroesophageal reflux disorder (GERD) should be limited to four weeks but is often continued beyond the recommended limit. Continued use can result in rebound acid hypersecretion and hypergastrinemia after 4–8 weeks of therapy leading to chronic use.”

Such research may seem abstract to many people. But if PPIs and kidney damage are a real thing, there are bound to be case reports. Here is just one person that contacted us on this website:

Micki in Huntsville, AL is responding to the two-week usage limit found on over-the-counter PPI packaging:

“Ha. Take only for 14 days. If only doctors had followed this. I was put on Aciphex and never told to take for just 14 days. I took it for 11 years! Yes, years! As a result, I am in stage 3 kidney failure!!!”

You can learn more about the problem of acid rebound and hyperacidity at this link:

How Can You Get Off a PPI Without Withdrawal?

If all this seems daunting, you may find our one-hour interviews with experts of great interest. These public radio podcasts are free!

Share your own experience with PPIs in the comment section below.

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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.”.
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