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.
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.
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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.
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.
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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.
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.
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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.
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.
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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.
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.
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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.
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.”
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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.
“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.
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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.
“The constellation of findings – the totality of evidence – is compelling, ” Xie said. “The public and the medical community should be aware of the possible risk and should exercise judicious use of PPI and limit use to where it is medically necessary and to the shortest duration possible.”
The researchers called for further study about the safety of PPIs. “We are interested in leveraging the availability of big data, including VA data and other data sources, to advance our understanding of potential long-term adverse events of widely prescribed pharmaceuticals, ” Xie said. “The goal is to transform data into knowledge that would promote better vigilance around pharmaceuticals as well as advance and protect public health.”Long-term use of a common type of medication used to treat heartburn, acid reflux, and ulcers may lead to an increased risk of kidney disease and kidney failure, new research shows.
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The study, published in the Journal of the American Society of Nephrology, adds to prior research that suggests proton-pump inhibitors (PPIs), a group of drugs which reduces gastric acid production, can lead to serious kidney damage.
The paper notes that an estimated 15 million Americans were prescribed PPIs in 2013, though the authors point out that the number is likely higher as many, including Prilosec, Nexium, and Prevacid, are available over the counter.
To assess the safety of these medications, the researchers analyzed information from the Department of Veterans Affairs national databases. They identified over 170, 000 new users of PPIs and compared them to over 20, 000 new users of histamine H2 receptor blockers, an alternative class of drugs also used to suppress stomach acid.
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Over five years of follow-up, the results showed that 15 percent of people using PPIs were diagnosed with chronic kidney disease, versus 11 percent of those on H2-blockers.
After controlling for other factors, including age and other diseases, this translated to a 28 percent increased risk of developing kidney disease for PPI users.
Only a few patients in the study -- less than 0.2 percent -- developed end-stage kidney failure, but the risk was 96 percent higher for those on PPIs.
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Researchers from Johns Hopkins University came to a similar conclusion linking use of PPIs to kidney damage in a study published earlier this year in JAMA Internal Medicine.
Both studies show an association and do not prove a cause and effect relationship, and the authors say other factors may be at play. However, they note that the results underscore an important point: [patients should] use PPIs only when it is medically necessary, and should limit duration of exposure to the minimum necessary to treat the underlying medical condition, study author Dr. Ziyad Al-Aly of the Clinical Epidemiology Center at the VA Saint Louis Health Care System, told CBS News in an email.
Dr. Kenneth R. DeVault, president of the American College of Gastroenterology and chair of medicine at Mayo Clinic in Jacksonville, emphasizes that although the risk appears to be real, it is overall very low.
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Keep in mind that the study population was a veteran's hospital, a relatively older population that had lots of other diseases, he told CBS News. One would have to assume if you were the average healthy person taking a proton pump inhibitor for heartburn the odds would be even lower than the low odds in this study.
Still, he said, the study provides further evidence that people who
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