Heartburn Drug May Cause Sudden Chronic Kidney Disease

Sudden kidney symptoms often prompt physicians to discontinue a patient’s long-term treatment with proton pump inhibitors (PPIs) to treat gastrointestinal conditions. Common branded drugs include Prevacid, Proliosec, Nexium, and Protonix, but over-the-counter drugs may also pose a risk to kidney health.

Findings from a new study published by Kidney International show that a majority of patients who experience chronic kidney damage may not have previously experienced acute kidney problems.

These findings show that patients may be unaware of symptoms that indicate a decline in kidney function. Physicians and patients should take a more active approach to monitor kidney function while taking PPIs to prevent irreversible organ damage.

Unfortunately, this may be difficult since the onset of acute kidney problems is not always a concrete warning sign for a decline in organ function.

"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,” said senior study author Ziyad Al-Aly, MD. “Patients should be cautioned to tell their doctors if they're taking PPIs and only use the drugs when necessary."

Approximately 15 million Americans with heartburn, ulcers, and acid reflux are prescribed PPIs, which reduce gastric acid and ease symptoms. Millions more individuals take the drugs over-the-counter without physician guidance, and may be largely unaware of the associated risks.

Included in the study were 125,596 patients treated with PPIs and 18,436 treated with H2 blockers, which are an alternate heartburn drug that is less likely to induce kidney problems. The data was gathered from the Department of Veterans Affairs databases.

After 5 years, the investigators found that more than 80% of PPI users did not develop acute kidney problems, which are typically reversible and characterized by decreased urination, fatigue, and swelling, according to the study.

Interestingly, more than 50% of patients who developed chronic kidney damage and end-stage renal disease linked to PPI use did not experience acute kidney problems. Only 7.67% of patients using H2 blockers developed chronic kidney disease without previous problems, and 1.27% developed end-stage renal disease, according to the study.

These findings highlight a potentially harmful side effect of long-term PPI use that could be averted through increased physician monitoring and patient awareness. Additionally, physicians should assess each patient to determine if treatment with H2 blockers would be appropriate.

"Doctors must pay careful attention to kidney function in their patients who use PPIs, even when there are no signs of problems," Dr Al-Aly concluded. "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."