Prolonged use of popular heartburn drugs linked to silent, gradual kidney damage

Taking popular heartburn drugs for prolonged periods has been linked to serious kidney problems, including kidney failure. The sudden onset of kidney problems often serves as a red flag for doctors to discontinue their patients' use of so-called proton pump inhibitors (PPIs), which are sold under the brand names Prevacid, Prilosec, Nexium and Protonix, among others.

But a new study evaluating the use of PPIs in 125,000 patients indicates that more than half of patients who develop chronic kidney damage while taking the drugs don't experience acute kidney problems beforehand, meaning patients may not be aware of a decline in kidney function, according to researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System. Therefore, people who take PPIs, and their doctors, should be more vigilant in monitoring use of these medications.

The study is published Feb. 22 in Kidney International.

"The onset of acute kidney problems is not a reliable warning sign for clinicians to detect a decline in kidney function among patients taking proton pump inhibitors," said Ziyad Al-Aly, MD, the study's senior author and an assistant professor of medicine at Washington University School of Medicine. "Our results indicate kidney problems can develop silently and gradually over time, eroding kidney function and leading to long-term kidney damage or even renal failure. Patients should be cautioned to tell their doctors if they're taking PPIs and only use the drugs when necessary."

More than 15 million Americans suffering from heartburn, ulcers and acid reflux have prescriptions for PPIs, which bring relief by reducing gastric acid. Many millions more purchase the drugs over-the-counter and take them without being under a doctor's care.

The researchers — including first author Yan Xie, a biostatistician at the St. Louis VA —analyzed data from the Department of Veterans Affairs databases on 125,596 new users of PPIs and 18,436 new users of other heartburn drugs referred to as H2 blockers. The latter are much less likely to cause kidney problems but often aren't as effective.

Over five years of follow up, the researchers found that more than 80 percent of PPI users did not develop acute kidney problems, which often are reversible and are characterized by too little urine leaving the body, fatigue and swelling in the legs and ankles.

However, more than half of the cases of chronic kidney damage and end-stage renal disease associated with PPI use occurred in people without acute kidney problems.

In contrast, among new users of H2 blockers, 7.67 percent developed chronic kidney disease in the absence of acute kidney problems, and 1.27 percent developed end-stage renal disease.

End-stage renal disease occurs when the kidneys can no longer effectively remove waste from the body. In such cases, dialysis or a kidney transplant is needed to keep patients alive.

"Doctors must pay careful attention to kidney function in their patients who use PPIs, even when there are no signs of problems," cautioned Al-Aly, who also is the VA's associate chief of staff for research and education and co-director of the VA's Clinical Epidemiology Center. "In general, we always advise clinicians to evaluate whether PPI use is medically necessary in the first place because the drugs carry significant risks, including a deterioration of kidney function."


  1. Christopher White Christopher White United States says:

    I hate to be suspect of the motives of this author but I can't help feeling that the intent is to confuse and scare thereby promoting under-utilization and therefore resulting in cost-savings. Here is my point - using the numbers referenced in the story:  125,596 VA patients who are new users of PPIs; 18,436 VA patients are new users of H2-blockers; 80% of PPI users did not develop acute kidney problems (= 100,476 did not develop acute kidney problems but there is no mention what percentage or what number of these patients developed chronic kidney problems); 50+% of PPI patients who developed chronic kidney problems never had acute kidney problems (but again there is no mention of what total percentage or what total number of patients out of the 125,596 actually developed acute or chronic kidney problems);  "in contrast" among new users of H2 blockers, 7.67 percent developed chronic kidney disease in the absence of acute kidney problems, and 1.27 percent developed end-stage renal disease (there is actually NO CONTRAST because there are not actual numbers to compare because similar percentages for PPI users were not provided) - we are given real percentages for H2-blocker users whereas these same percentages are not provided succinct or clear manner for PPI users.

    Whereas there is no doubt in my mind that there are legitimate concerns regarding the use of these medications, I cannot help but ask why did the author not clearly indicate what percentage of PPI users actually developed chronic kidney disease (e.g.  5% [or 6,279 patients] or 10% [or 12,560 patients], etc).  Please, author, just give us the facts or learn how to write true comparison articles.

  2. Debbie Wood Debbie Wood United States says:

    So I have a choice now between esophogeal cancer and kidney failure?  I have severe gerd, and had Barretts Esophagitis a few years ago.  Since being on the Proton inhibitors, my Esophogus has improved dramatically.  Kidney disease also runs in my family.  So what do I choose?  This is something I will discuss with my doctor.

  3. Wilbert Mesidor Wilbert Mesidor United States says:

    I went to see a doctor, he said that I had acid reflux, since then, I've started dealing with hearthburn, and bad breath and large taste buds in the back of my tongue. OK that was 5 months ago then now I am with all of them plus sore throat and severe headache and ears ringing.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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