April 20, 2016 — Long-term use of anti-heartburn medications in the Proton-Pump Inhibitor (PPI) class has been linked to a 96% increased risk of kidney failure and a 26% increased risk of chronic kidney disease in a study published in the Journal of the American Society of Nephrology.
Conclusions were based on data from the U.S. Department of Veterans Affairs, including 173,321 people who used PPIs and 20,270 people who used a non-PPI heartburn drug like Pepcid or Zantac (also known as H2-blockers).
After five years, 15% of patients on PPIs had been diagnosed with chronic kidney disease, compared to 11% of those on H2-blockers. Very few patients in the study — less than 0.2% — developed end-stage kidney failure, but the odds were almost doubled among PPIs users. The risk also increased over time, with patients on PPIs for 1-2 years having a tripled increased risk of kidney failure compared to patients who used PPIs for a month or less.
The study was conducted by researchers at Washington University in St. Louis and the Clinical Epidemiology Center at the VA in St. Louis. According to the author of the study, Dr. Ziyad Al-Aly:
“I think people see these medications at the drug store and assume they’re completely safe. But there’s growing evidence they’re not as safe as we’ve thought. [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.”
This is the first major study to link PPIs and kidney failure, but not the first to find elevated rates of kidney disease. Earlier this year, a study published by JAMA Internal Medicine found a 46% increased risk of chronic kidney disease associated with twice-daily doses of PPIs. Another study published in CMAJ Open found that PPI users were three times more likely to develop nephritis (kidney inflammation).
The FDA updated the label on all PPIs to include acute interstitial nephritis in December 2014. PPIs are some of the most popular drugs in the world, used by about 15 million Americans. Some of the most popular PPIs include:
- Aciphex (rabeprazole)
- Dexilant (dexlansoprazole)
- Nexium (esomeprazole)
- Prevacid (lansoprazole)
- Prilosec (omeprazole)
- Protonix (pantoprazole)
- Vimovo (naproxen / esomeprazole)
- Zegerid (omeprazole / sodium bicarbonate)
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