The People's Perspective on Medicine

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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About a decade ago after endoscopy for reflux I received two recommendations for fundiplasty and was placed on a non OTC rx. I, having worked in a pharmacology lab, researched other possibilities. I began taking DGL capsules often prescribed for reflux in Europe. Nary a problem since. Retested several times since … clean. Surgeons operate. Physicians prescribe corporate meds. Enough said.

I was taking Aciphex for heartburn and GERD for several years before I stopped. I had painful kidney stones late one night, went to the ER and continued on the drug. I later read articles about new findings of kidney disease/damage and PPIs. I discussed this with my doctor who suggested I wean off the drug and try PEPCID AC. I did and have been using it now for several years. It works great, no big Pharma involved, and all-over better for me. Pharma doesn’t make big money off OTC non-prescriptions. People need to be their own advocates, research, seek alternatives, and ask more questions.

I was prescribed Prilosec by my family doctor and took it for about 3 years. I quit taking it after reading about an association between PPI’s and hip fractures. Then I saw on the People’s Pharmacy that there was a link with PPI’s and kidney problems. After I had been off of it for about a year, I had blood work done and was told I was in Stage 3 kidney failure!

I have no risk factors for kidney disease (high blood pressure, diabetes, etc.) For 2 years, my kidney function remained stable. Then in July of last year, my GERD was so bad that I went to a gastroenterologist who did an endoscopy. She asked my why I had quit taking Prilosec. I told her about the kidney failure and she said PPI’s do not cause it. She then prescribed a low dose of Protonix and said it should not affect my kidneys.

My family doctor checked my kidney function 3 months later and it had declined. I then saw a nephrologist and he said to never take PPI’s. He said Pepcid is okay so I now take Pepcid AC. I tell everyone I know who takes PPI’s about the risk for kidney problems!

I have been prescribed different PPIS since 2002. Now I have horrible back and hip pain and am going to a Urologist to see about kidney damage. The medicine does not even work. I called the Gastro Dr. and told them and got the same response. “Are you taking as prescribed 2 a day?” I feel horrible. H2 Blockers dry my eyes so the Eye Dr. says I have dry spots on the Cornea. What part of your body do they not destroy? Having MRIs next week to see back damage, etc., etc., etc.

I tried two PPIs years ago, and had very problematic side effects with each. So, I went back to using Zantac, with no problems. In view of all the problems with PPIs coming to light recently, I am now very thankful that I was unable to take them.

regarding PPIs, I was alerted to this by your news letter. Thank you. I have renal failure and could not understand why I had lower extremity edema. Read your article and stopped them immediately Again thank you.

Doctors and patients are not following basic sensible advice:
1. Make sure you actually need the drug. There may be other ways to solve the problem.
2. Take the minimum amount of the drug that you need.
3. Take the drug for the minimum amount of time unless it’s for a chronic condition.

Nor everyone takes a PPI for GERD (reflux). I have Barrett’s esophagus, a pre-cancerous condition and reflux puts me at higher risk of actually developing cancer. My gastroenterologist prescribed Prilosec (omeprazole) in 2007 and I’m still taking it. As a nurse, in conjunction with my physician, we monitor the known associations with use of the drug. I have zero symptons, and all testing shows me all in the clear. Yea!

My husband was on one for 8 years, suffering a total kidney shutdown in the second year followed by 7 years of “chronic kidney disease”. His doctor didn’t make the connection. He died 8 years after starting PPI’s of esophagheal cancer. Could PPI’s also be a factor in developing gastrointestinal cancers?

Hi there – i have been reading about taking heartburn/acid reflux medication – i only have one kidney (lost the other one due to doctors neglect) i get a lot of pain from my one kidney and the doctor keeps giving me Lansoprazole for acid reflux – i also have pernicious anemia and vitamin D deficiency and folate deficiency – my doctor will not treat me and i feel like i am dying – my eyes are affected – i have very bad pain – cold all the time – urinate a lot – spotty – losing my hair – have an enlarged fatty liver – hiatus hernia – fybromyalgia/osteoarthitis and the list goes on – but i cannot get help – i also have been diagnosed with sub clinical hypothyroidism – what can i do to help my self – i appreciate any help you can give me. Thank you.

It sounds as though you may need a second opinion. Your hypothyroidism is not really subclinical if you have symptoms such as feeling cold all the time and losing your hair. Your hiatal hernia may be responsible for your heartburn. Ask the doctor if there is some other way of treating it. (At the very least, ask about switching to an H2 blocker such as ranitidine [Zantac] or famotidine [Pepcid]. They don’t appear to injure the kidneys.)

I started on Prevacid for an ulcer in 1998 at the age of 32. Then the reflux that I had frequently experienced since my early teenage years increased in frequency and intensity, so my gastroenterologist kept me on Prevacid – and then Prilosec due to a change in my insurance – for the next 18 years, and it worked very well controlling my GERD. Then when the news broke about all of the issues with PPI’s, I weaned myself off Prilosec and started taking famotidine with great success, and I remain on it today to control my GERD. The interesting thing is that I had two kidney stones prior to starting on PPI’s in 1998 (one each in 1991 and 1996), but during the 18 years I was on PPI’s, I had ten more stones. And since I stopped Prilosec two years ago, I have not had another stone. The only dietary change I made during all those “stone years” was eliminating nearly all oxylates for one year, and I still got a stone during that year, so I returned to my normal diet and continued getting stones. I find this new information about the link between kidney stones and PPI’s to apparently be true in my case.

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