Heartburn Drugs May Increase Risk Of Kidney Disease : Shots - Health News Medications for heartburn called proton pump inhibitors are linked to a higher risk for chronic kidney disease, according to a study. It's the latest in a growing list of worries with these drugs.
Nexium is one of several popular medications for heartburn and acid reflux called proton-pump inhibitors. Daniel Acker/Bloomberg via Getty Images hide caption
The drugs, known as proton-pump inhibitors (PPIs), appear to significantly elevate the chances of developing chronic kidney disease, according to a study involving more than 250, 000 people.
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An estimated 15 million Americans use PPIs, which are sold by prescription and over-the-counter under a variety of brand names, including Nexium, Prilosec and Prevacid.
They're very, very common medications, says Morgan Grams, an epidemiologist at the Johns Hopkins Bloomberg School of Health who led the research, being published in the journal
When PPIs were first approved in the 1980s, the drugs appeared to be very safe. Since then, concerns have been rising about their safety. Evidence has emerged that the drugs may increase the risk for a variety of problems, including bone fractures, infections and possibly even heart problems.
Gastroesophageal Reflux Disease (gerd)
Grams and her colleagues decided to examine whether PPIs might increase the risk for chronic kidney disease. They examined the medical records of two groups of people: 10, 482 participants in the Artherosclerosis Risk in Communities (ARIC) study and 248, 751 patients in the Geisinger Health System in Pennsylvania.
Among the 322 people using PPIs in the ARIC study, the 10-year estimated absolute risk for chronic kidney disease was 11.8 percent, the researchers reported. The expected risk would have been 8.5 percent. The 10-year absolute risk among the 16, 900 patients using PPIs in the Geisinger Health System was 15.6 percent, whereas 13.9 percent would have been expected to develop chronic kidney disease.
Grams said it isn't possible from these data to determine who is at highest risk of developing kidney disease. The study looked only at whether someone had gotten a prescription for a PPI and did not look at how long someone may have been on the drug.
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Grams also stressed that her study does not prove that the drugs can cause chronic kidney disease. More research is needed to explore the association she found, she says.
I think it's a pretty big concern, says Adam Schoenfeld, an internal medicine resident at the University of California, San Francisco, who co-authored an editorial accompanying the study.
When they first came out they weren't associated with side effects, or we didn't think they were, Schoenfeld says. So we put [people] on this medication thinking: 'It's a quick fix and they're very safe.' But in actuality they're associated with a range of side effects.
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Schoenfeld says people should try other measures first to alleviate heartburn and indigestion. For example, people often feel better if they change their diet, stop smoking or reduce their alcohol consumption, he says.
Patient safety is an important priority for AstraZeneca and we believe all of our PPI medicines ... are generally safe and effective when used in accordance with the label.
She added: We encourage patients to work with their health care provider to determine the most appropriate treatment approach based on their individual needs.The drugs, called proton pump inhibitors (PPIs), reduce the symptoms of heartburn by lowering the amount of acid in the stomach. They include the brand names Losec, Nexium, and Prevacid.
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Doctors previously monitored patients for acute kidney problems, such as decreased urination, swelling in the legs, ankles, or feet, and nausea. Such symptoms were thought to be a warning of more permanent kidney damage, and would often result in doctors taking patients off the drugs.
It's a silent disease, in the sense that it erodes kidney function very minimally and very gradually over time, said Ziyad Al-Aly, the study's senior author and assistant professor of medicine at Washington University School of Medicine.
Al-Aly and his colleagues analyzed data from 125, 000 U.S. patients using PPIs and found more than half who went on to develop chronic kidney damage had no prior acute kidney problems.
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The study also found that people using PPIs had, on average, a 20 per cent increase in developing chronic kidney disease compared with those taking H2 blockers such as Zantac or Pepcid. Those medications also reduce the production of stomach acid and are available over the counter.
Kidney problems remain rare in those taking PPIs, and the study does not prove causation. But Al-Aly notes that even a small potential increase in risk can be a big deal with a drug taken by millions of people.
PPIs are among the most commonly prescribed medications in Canada, according to the Canadian Institute for Health Information, and many patients take them for years.
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It's not the first time that PPIs have led to health concerns. Their use has been linked to increased rates of fractures, pneumonia, the gut infection C. difficile, and low vitamin B12 and magnesium levels.
These drugs, should be used at the lowest dose and for the shortest duration appropriate for the condition being treated, according to Health Canada.
Emily McDonald, an internal medicine specialist at McGill University Health Centre in Montreal, suggests trying other interventions such as altering diet before PPIs, and where they are necessary, following up regularly to re-evaluate whether a patient needs to continue using them.
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This is another article that makes us think again about how many people are on these medications, and how many are on them unnecessarily, she said.
Al-Aly emphasizes that PPIs do a lot of good for people who need them, such as those with gastrointestinal bleeding or ulcers. But he recommends doctors de-prescribe those who don't need to be taking them.Extended use of drugs to treat heartburn, ulcers and acid reflux may lead to serious kidney damage, including kidney failure, according to a study by researchers at Washington University School of in St. Louis and Veterans Affairs St. Louis Health Care System.
More than 15 million Americans have prescriptions for so-called proton pump inhibitors (PPIs), which decrease gastric acid production and generally have been considered safe.
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Furthermore, researchers found the risk of kidney problems rises the longer patients take the medications, sold under the brand names Prevacid, Prilosec, Nexium and Protonix, among others.
“We advise patients to limit the use of PPIs only to when they are medically necessary and for the shortest duration possible, ” said Ziyad Al-Aly, MD, an assistant professor of at Washington University and the study’s senior author.
In collaboration with scientists at the Veterans Affairs’ Clinical Epidemiology Center, Washington University researchers examined national VA databases to identify 173, 321 new users of PPIs and 20, 270 new users of an alternative class of stomach-acid suppressing drugs called histamine H2 receptor blockers. Following the patients for five years, the researchers found that chronic kidney disease affected 15 percent of PPI users who took the drugs over the course of the study compared with 11 percent of H2 blockers. After controlling for factors such as age and other health conditions that PPIs were associated with, researchers found a 28 percent increased risk of kidney damage among PPI users.
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PPI users also were at a significantly higher risk – 98 percent – of developing kidney failure compared with users of H2 blockers, although this occurred in less than 1 percent of the overall patients studied.
“The general assumption is that PPIs as a drug class are safe, ” said Al-Aly, who also is the VA’s associate chief of staff for research and education and co-director of the Clinical Epidemiology Center. “PPIs do not receive the same level of scrutiny as many other drugs in terms of indication for initiating treatment and duration of therapy.”
Similar studies – including one published earlier this year by researchers at Johns Hopkins University in The Journal of the American Medical Association – reached similar conclusions about the elevated risks of PPIs. Other studies have linked PPIs to health problems such as fractured bones and infections.
Gastroesophageal Reflux Disease
“Nephrologists have been aware that PPIs can cause injury to the kidneys through an allergic reaction, but this has been felt to be exceedingly rare, ” said Benjamin Humphreys, MD, PhD, an associate professor and director of the School of ’s Division of Nephrology. “This important study suggests that kidney damage may be far more common than anyone suspected. The large number of patients analyzed provides significant power to bolster the team’s conclusions.”
The new research does not provide direct evidence that PPIs cause kidney damage. However, potential negative connections need to be taken seriously, especially since PPI use is so widespread, said Yan Xie, the study’s lead author and a biostatistician at the Clinical Epidemiology Center.
Xie added that the number of people taking PPIs is likely higher than 15 million because the figure does not include PPIs bought over-the-counter without prescriptions. The drugs are popular because they quickly relieve symptoms of heartburn and other conditions linked to increased stomach acid.
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“The constellation of findings – the totality of evidence – is compelling, ” Xie said. “The public and the medical community should be aware of
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