Recent Medical Journal Articles Report That Proton Pump Inhibitors May Be Linked To Chronic Kidney Disease And Acute Renal Injury
Prilosec, Prevacid, and Nexium are in the proton pump inhibitors (PPIs) class of drugs and are used regularly by many people to treat heartburn and acid reflux. These medications are available by prescription and over-the-counter (OTC) from various pharmaceutical companies. Such medications include:
PRILOSEC (omeprazole magnesium) | prescription drug | AstraZeneca LP
PRILOSEC OTC (omeprazole magnesium) | over-the-counter | Procter & Gamble Manufacturing Co.
PREVACID (lansoprazole) | prescription drug | Takeda Pharmaceuticals America, Inc.
PREVACID 24 HR (lansoprazole) | over-the-counter | Novartis Consumer Health, Inc.
NEXIUM (esomeprazole magnesium) | prescription drug | AstraZeneca LP
NEXIUM 24HR (esomeprazole magnesium) | over-the-counter | Pfizer Consumer Healthcare
For many, if not most, people using any of those widely advertised drugs, the following drug safety information will probably come as quite a surprise, given that it has not received much attention, yet.
There is mounting medical evidence that the use of these proton pump inhibitors (PPIs) results in an increased risk of developing chronic kidney disease (CKD) as well as CKD disease progression and end-stage renal disease (ESRD). Further, the latest medical study shows that with greater use over time of heartburn pills like Prevacid, Prilosec, and Nexium, comes a greater risk of developing these serious side effects.
This medical journal article, "Proton Pump Inhibitors and Risk of Incident CKD and Progression to ESRD", published April 14, 2016 in the Journal of the American Society of Nephrology (JASN), reports on researchers' analysis of national Veterans Administration databases to investigate this still emerging drug safety issue involving Nexium and other PPIs. From the Abstract for this April 2016 JASN article, we get this brief overview of their findings:
The association between proton pump inhibitors (PPI) use and risk of acute interstitial nephritis has been described. However, whether exposure to PPI associates with incident [chronic kidney disease (CKD)], CKD progression, or [end-stage renal disease (ESRD)] is not known.... Our results suggest that PPI exposure associates with increased risk of incident CKD, CKD progression, and ESRD.
And a few months ago, similar findings -- from researchers at The Johns Hopkins University, Yale University School of Medicine, and two other institutions -- were reported in this "Original Investigation" article, "Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease", which was initially published in January 2016 (early online release date) by the medical journal JAMA Internal Medicine (and later in the February 2016 print edition).
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For a summary of findings in that article as well as some contextual information, we go to this HealthDay news report, "Common heartburn drugs linked with kidney disease":
People who use proton pump inhibitors (PPIs) have a 20 percent to 50 percent higher risk of chronic kidney disease compared with nonusers, said lead author Dr. Morgan Grams, an assistant professor of epidemiology at Johns Hopkins University in Baltimore.
The study was published Jan. 11 in JAMA Internal Medicine.
The study doesn't establish a direct cause-and-effect relationship between the drugs and chronic kidney disease. However, Grams said, "We found there was an increasing risk associated with an increasing dose. That suggests that perhaps this observed effect is real."
Proton pump inhibitors were used by more than 15 million Americans in 2013, according to background notes.
But as many as 70 percent of these prescriptions have been handed out inappropriately, and 25 percent of long-term users could stop taking the medication without suffering increased heartburn or acid reflux, the study authors said.
Use of the prescription heartburn drugs already has been linked to short-term kidney problems such as acute kidney injury and an inflammatory kidney disease called acute interstitial nephritis, Grams said.
Newer studies now show a link between the drugs and chronic kidney disease, in which the kidneys lose their ability to filter blood effectively.
Over time, chronic kidney disease can lead to kidney failure, forcing someone to undergo regular dialysis and possibly a kidney transplant, according to the U.S. National Institutes of Health.
Now we shift our focus from the long-term, chronic kidney disease (CKD) side effect possibly associated with heartburn and acid reflux drugs such as Nexium, Prevacid, and Prilosec, to the more immediate, acute renal / kidney injury side effect, of which there is an apparent increased risk.
About a year ago, back in April 2015, this article, "Proton pump inhibitors and the risk of acute kidney injury in older patients: a population-based cohort study", was published online at the CMAJ Open site. From the Abstract for that article, reporting on a study done by Canadian medical researchers, we get this overview information:
- Background Proton pump inhibitors (PPIs) cause interstitial nephritis and are an underappreciated cause of acute kidney injury. We examined the risk of acute kidney injury and acute interstitial nephritis in a large population of older patients receiving PPIs.
- Results We studied 290 592 individuals who commenced PPI therapy and an equal number of matched controls. The rates of acute kidney injury (13.49 v. 5.46 per 1000 person-years, respectively; hazard ratio [HR] 2.52, 95% CI 2.27 to 2.79) and acute interstitial nephritis (0.32 vs. 0.11 per 1000 person-years; HR 3.00, 95% CI 1.47 to 6.14) were higher among patients given PPIs than among controls.
- Interpretation In our study population of older adults, those who started PPI therapy had an increased risk of acute kidney injury and acute interstitial nephritis. These are potentially reversible conditions that may not be readily attributed to drug treatment. Clinicians should appreciate the risk of acute interstitial nephritis during treatment with PPIs, monitor patients appropriately and discourage the indiscriminate use of these drugs.
To be clear, we are not suggesting that anyone stop using proton pump inhibitors based on the findings of these three medical studies regarding drugs like Nexium, Prevacid, and Prilosec. Rather, people who use these PPIs regularly, whether by prescription or over-the-counter, might want to talk with their doctor about whether they really need to use one of these drugs in view of the possible links with chronic kidney disease and acute renal or kidney injury.
We will continue to monitor the medical literature for further developments regarding the kidney-related side effects of Nexium, Prevacid, Prilosec, and other heartburn medications (prescription and OTC) in the PPI class of drugs.