A new study published in the February 2016 JAMA (Journal of the American Medical Association) – Internal Medicine, found that common over-the-counter (OTC) medications used to treat acid reflux might be associated with an increased risk of long-term kidney damage. Prevacid, Nexium and Prilosec belong to a class of drugs called proton pump inhibitors, or PPIs, that work by decreasing the amount of acid in the stomach.
The study evaluated data on 250,000 outpatient PPI users from a healthcare system in Pennsylvania, and data from 10,000 self-reporting PPI users who participated in a national study. Results showed that PPI users had a 20 – 50% greater risk of developing chronic kidney disease than in people who do not use PPIs. Chronic kidney disease can cause kidneys to lose their ability to filter blood, which can, in turn, lead to kidney failure and ultimately to the need for dialysis or a transplant.
Previous studies found evidence of short-term kidney problems with PPI use but this study found an increased risk of kidney damage and chronic kidney disease in patients with continued use of PPIs over a 10-year period.
The study also showed a dramatic increase in kidney damage risk depending on whether a patient uses PPIs once or twice a day. Patients using PPIs once a day have a 15% increased risk of developing chronic kidney disease, whereas twice-a-day users have a 46% increased risk.
More than 120 million acid reflux prescriptions are filled each year in the United States and the authors believe PPIs are over-prescribed and many people taking PPIs do not need to be taking them to treat their acid reflux. Specialists are increasingly cautious about prescribing PPIs, which are already linked to increased risk of bone fractures and increased risk of heart attacks as we reported in an earlier blog.
Other medications are available to treat acid reflux without the dangerous risks associated with PPIs. This class of drugs, known as H2 blockers, are available over-the-counter and include well-known drugs such as Pepcid, Tagamet, and Zantac.
It should be noted this study is not a clinical study but rather a data study. The distinction is important because researchers stress their conclusions do not prove cause-and-effect relationship but rather suggest there may be a problem with long-term PPI use and kidney damage. Researchers also stress that they do not know how the PPI drugs cause kidney damage although there are two theories including decreased magnesium levels from the medication or acute kidney inflammation problems caused by long-term use of PPIs.
The study’s authors caution that PPI users should not abruptly stop taking their PPI medication but should consult their prescribing doctor or healthcare provider about whether they need to continue taking PPIs, or whether their acid reflux can be treated with one of the above-listed H2 blockers, or with lifestyle changes.