The People's Perspective on Medicine

PPIs and Kidney Damage | Nephrologist Spanks GI Doc

Proton pump inhibitors (PPIs) are popular with GI doctors. But is there a link between PPIs and kidney damage? What about PPIs and kidney stones?

Many specialists live in silos. By that we mean they hang out with other experts like themselves. They reinforce each other’s understanding of the world. These specialists may not hang out with authorities in other fields of medicine. As a result, they be unaware of the complications of the medicines they prescribe. This appears to have happened with the patient below who contacted us. He believes there is a connection between PPIs and kidney damage. Another reader links PPIs and kidney stones.

A GI Doctor Rejected the Idea of PPIs and Kidney Damage:

Q. My family doctor prescribed Prilosec (omeprazole) and I took it for several years. I quit taking it after I read that PPIs are associated with hip fractures.

Then I read your article about a link between PPIs and kidney problems. I had been off the drug for at least a year when I had blood work done. I was told I was in Stage 3 kidney failure!

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

My family doctor checked my kidney function three months later, and it had declined. I then saw a nephrologist and he said I should never take any PPI again. He said Pepcid [famotidine] is okay, so I now take Pepcid AC. I tell everyone I know who takes PPIs about the risk for kidney problems.

A. Thank you for sharing your story. It illustrates the problem of healthcare specialists in “silos” that may not interact very much.

The evidence that acid-suppressing drugs like proton pump inhibitors (PPIs) can damage the kidneys is well established (Clinical Gastroenterology and Hepatology, May 2006; Scientific Reports, Feb. 19, 2019; and others). In addition, there is evidence that continued use of PPIs may make existing kidney disease worse (Gastroenterology, Sep. 2017). We think that gastroenterologists need to be aware of the link between PPIs and kidney damage. 

Pepcid AC belongs to a different category of medication that has not been associated with harm to the kidneys. We agree with your kidney specialist that famotidine would be a safer option given the degree of damage you have already suffered.

You will find ten questions to ask when you get a prescription in our book, Top Screwups Doctors Make and How to Avoid Them. They should help you overcome the silo effect and avoid medication problems. The book is available in your library or online at www.PeoplesPharmacy.com.

PPIs and Kidney Stones?

We received an intriguing letter from Joseph in Mechanicsville, VA. It was not about PPIs and kidney damage but it was about PPIs and kidney stones.

“I started on Prevacid [lansoprazole] 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. 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. 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.

“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.”

Any Validity to PPIs and Kidney Stones?

A study published in the journal Nutrients (Sept. 11, 2018) discussed a link between PPIs and kidney stones.

The authors note:

“Within the PPI cohort, patients who received the following PPIs as ‘monotherapy’ had a significant increase in the frequency of nephrolithiasis [kidney stone] reports: omeprazole (OR 3.4 [1.4, 7.9]), esomeprazole (2.4 [1.1, 5.3]), pantoprazole (3.3 [1.2, 8.6]), and lansoprazole (3.9 [1.5, 10.1]).”

That means people taking omeprazole, lansoprazole or pantoprazole were at least three times more likely than those not on such drugs to report kidney stones. Read more about PPIs and kidney damage at this link:

More Bad News About PPIs and Kidney Damage

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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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These are great articles.
As for the post regarding kidney stones and oxylate, it is important to eat a low oxylate diet if one has calcium oxylate stones. There are many lists with the oxylate content of foods but it appears that the Harvard list is the most accurate.

It is also important to know about many other things to prevent kidney stones besides avoiding PPIs and oxalate, and this info (including the Harvard list) can be found at Jill Harris kidney stone prevention diet on FB. It is based on research by Dr. Fred Coe at the University of Chicago.

My nephrologist says that he doesn’t believe that the PPIs are responsible for the 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.

I stopped taking Pepcid for GERD and now I take 2 Tums for added calcium to my diet and it seems also to ease the Gerd. Are Tums OK?

Glad that some folks are getting the message on PPI’s. I was on them for many years, I have GERD. The current side effects and press about the damage that PPI’s can do was enough for me.

After some careful research I found DGL ( Deglycyrrhizinated Licorice Extract) I have watched what I eat, and use DGL after morning and evening meals. Only caution is the withdrawal from your PPI’s, it can take a few days to clear up.

I have experienced little acid reflux problems with the DGL. To the point of actually cutting back to a lesser dose at meal times. Do your research on this product, you will be amazed. Good luck.

I’ve taken a “otc store brand “ omeprazole magnesium for about 5 years. Recently I’ve switched to “otc store brand Esomeprazole Magnesium.

The doctor that performed my latest colonoscopy (within the last 5 years) advised that it was perfectly safe to take this every day and as long as the “magnesium” was included there would be no harm to my kidneys.

At my latest “Medicare wellness appointment” with my primary care doctor, the blood work shows a disturbing number for my kidney function. My primary care doctor is aware that I take the Esomeprazole Magnesium, but there was no mention that it could be causing the disturbing numbers to kidney function.

I’ve “read” through most of the comments here, but have not seen the word “magnesium” mentioned (I could have missed it), any thoughts would be appreciated

After seeing reports in the past three or so years re PPIs and kidney damage, I decided to ask my primary physician to find me an alternative to the PPI I was taking.

Before I had the chance to bring it up with her at my visit, she told me she wanted me to wean off taking the PPI, and recommended Famotidine.

That should tell you something. So far, my kidney function tests are OK.

For GERD a GI doctor prescribed both PPI and H2 blockers. I started having cardiac arrhythmia. Then I saw a cardiologist, and he told me to stop both of them. The arrhythmia came under control. I now take sips of a solution of 1 teaspoon of baking soda which lasts for 1 and 1/2 days, and it helps me with improvement in Barrett’s metaplasia.

I have been on PPIs for 25 years. Before taking the medicines my GERD was so bad that my esophagus looked like raw meat, and Barrett’s Esophagus was diagnosed. Since then I have had no trouble with GERD, and the Barrett’s has disappeared. I do question my doctors about possible problems but so far my yearly blood work is fine, and I am maintained on a minimal dose of Nexium. Other meds like Tagamet and Zantac did not solve my esophageal problems. My case may be an anomaly but I have been fortunate to have a medicine that works well for me.

I can vouch for the link between taking a PPI and stage 3 kidney disease. I am a victim. I quit taking the PPIs upon learning of my kidney disease and am holding steady now. Changing from the PPI was a fairly easy process. I went to Zantac, and it works well in controlling my GERD. Personally, I feel all PPIs should be banned. They are so detrimental to good health.

I have also been one whose GI doc continues to prescribe Prevacid in spite of my expressed concerns about kidney failure. I have weaned myself off of the medication, trying alternatives, in spite of being diagnosed with Barrett’s Esophagus. I will try using Pepcid AC and will keep my fingers crossed after my next endoscopy and hope that the Barrett’s has not advanced .

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