Long-term use of proton pump inhibitors – popular drugs commonly used to treated heartburn, acid reflux and ulcers – could lead to kidney damage and severe kidney disease.
This was the conclusion researchers came to after analyzing large collections of patient data held in the Department of Veterans Affairs (VA) national databases. They report their findings in the Journal of the American Society of Nephrology.
Proton pump inhibitors (PPIs) reduce the stomach acid made by glands in the lining of the stomach. This is not the same as antacids, which reduce excess acid after it enters the stomach.
PPIs are also used to treat peptic or stomach ulcers and damage to the lower esophagus caused by acid reflux. There are many names and brands of PPIs. Most work equally as well, although side effects may vary. Some are also available over the counter – that is, without a prescription.
Estimates for 2013 suggest that 15 million Americans were prescribed proton pump (PPIs) that year. The researchers suggest the actual number of PPI users in the US is likely to be higher, because some types are available without a prescription.
Common types of PPI include omeprazole (brand name Prilosec, also available over the counter), esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (AcipHex), pantoprazole (Protonix), dexlansoprazole (Dexilant) and Zegerid (omeprazole with sodium bicarbonate).
For their study, the team examined 5 years of VA records for 173,000 new users of PPIs and 20,000 new users of H2 receptor blockers – another type of drug that also suppresses stomach acid – and looked for incidence of kidney problems.
Their analysis finds that patients taking PPIs were more likely to experience declining kidney function than patients taking H2 receptor blockers.
PPI use was also linked to a 28% increased risk of developing chronic kidney disease and a 96% higher risk of developing complete kidney failure, compared with H2 blocker use.
The researchers note that the longer the duration of PPI, the higher the risk of kidney problems. They conclude long-term use of PPIs may cause harm to the kidneys and should be avoided.
Senior author Dr. Ziyad Al-Aly, a nephrologist with the VA Saint Louis Health Care System in Missouri, says their findings emphasize the importance of only using PPIs when strictly medically necessary, and also limiting the duration of use to the shortest possible. He notes:
“A lot of patients start taking PPIs for a medical condition, and they continue much longer than necessary.”
The study adds to a body of research that is raising questions about long-term use of PPIs.