Proton pump inhibitors tied to increased progression to kidney failure

By John Murphy, MDLinx
Published April 18, 2016

Key Takeaways

People who took proton pump inhibitors (PPIs) for months or years had a higher risk of kidney function decline and chronic kidney disease, and nearly double the risk of kidney failure, according to a study published online April 14, 2016 in Journal of the American Society of Nephrology.

The study also found that the longer that patients took PPIs, the more likely they were to develop kidney disease.

“A lot of patients start taking PPIs for a medical condition, and they continue much longer than necessary,” said study investigator Ziyad Al-Aly, MD, Assistant Professor of Medicine at Washington University School of Medicine and Associate Chief of Staff for Research and Education at the VA Saint Louis Health Care System in Saint Louis, MO.

Previous studies have already shown that PPIs are associated with acute kidney disease. In this study, researchers investigated whether people taking PPIs also have an increased risk of incident chronic kidney disease (CKD) and progression to kidney failure.

To find out, researchers identified 173,321 new users of PPIs selected from Department of Veterans Affairs national databases. The investigators compared these against 20,270 new users of H2 receptor blockers.

Over 5 years of follow-up, people taking PPIs were more likely to experience kidney function decline than those taking H2 receptor blockers. PPI users also had a 28% increased risk of developing CKD and a 96% increased risk of developing end-stage renal disease (ESRD). In addition, PPI use was related to increased progression of CKD to ESRD, the researchers found.

The findings also showed that people who took PPIs for a longer time were more likely to develop kidney problems. “The results emphasize the importance of limiting PPI use only when it is medically necessary, and also limiting the duration of use to the shortest duration possible,” said Dr. Al-Aly.

The results have implications for millions of patients with heartburn and acid reflux. An estimated 15 million Americans were prescribed PPIs in 2013, but this number is likely an underestimate because it doesn’t take into account over-the-counter sales purchased without prescriptions.

“Although it is premature to consider eliminating PPIs from over-the-counter availability, clinicians should always query their patients about use of these non-prescribed drugs,” wrote nephrologists Dennis G. Moledina, MBBS, and Mark A. Perazella, MD, of Yale School of Medicine in New Haven, CT, in a related editorial.

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