Those who suffer from chronic heartburn may have to add an additional heartburn concern to their list. Chronic heartburn drug use linked to kidney disease risk, according to a recently published study in the Journal of the American Society of Nephrology.
Those who suffer from chronic heartburn may have to add an additional heartburn concern to their list. Chronic heartburn drug use linked to kidney disease risk, according to a recently published study in the Journal of the American Society of Nephrology.
The drugs in question are both prescription and over-the-counter medications like Prevacid, Nexium and Prilosec. These are a class of heartburn drugs known as proton pump inhibitors (PPIs). Long-term use of these drugs has been linked to other health issues, as well. The FDA considers bone fractures a safety concern in patients who use PPIs for a year or longer, due to bone-density loss and other nutrient deficiencies.
A study published last year even suggested that long-term PPI use may even slightly increase heart attack risk. On the other hand, neither that study nor the most recent one proves that long-term PPI use is definitely causes these problems.
According to Dr. Ziyad Al-Aly, a kidney specialist with the Veterans Affairs St. Louis Health Care System and one of the recently published study’s researchers, “I cannot say for certain that this is cause-and-effect.”
Dr. Al-Aly’s team attempted to disprove other possible reasons, such as advanced age or poor health of the PPI users, but found that there could still be other issues involved in the increased risk of kidney disease. One thing the team discovered is that patients using PPIs were more likely to develop chronic kidney disease (CKD) over a five-year period than were patients using other heartburn drugs.
Even with the inconclusiveness of the causal link, Dr. Al-Aly said the results point to the important message that PPIs should be used only when medically necessary and for the shortest time period possible. He said, “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.”
Dr. Al-Aly isn’t the only physician with that opinion. Dr. F. Paul Buckley, the surgical director of the Heartburn & Acid Reflux Center at the Scott & White Clinic, in Round Rock, Texas, believes the problem is that many patients take PPIs for longer than is safe or when not medically necessary. He added that PPIs aren’t helpful, or even the right drug, for occasional heartburn.
Dr. Buckley advises that patients should see their doctors with heartburn concerns and obtain a diagnosis of true gastroesophageal reflux disease (GERD) before using PPIs. GERD is a chronic condition in which stomach acids move up into the esophagus due to a weakness in the muscle between the stomach and esophagus.
GERD is quite a common problem, too. According to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases, roughly 20% of Americans have GERD diagnoses. The Institute says that heartburn is a symptom of GERD and those who have heartburn more than twice weekly are likely to have GERD.
Dr. Buckley explained that PPIs work well for patients with more-severe GERD, especially those who are experiencing esophageal inflammation or ulcers. The stomach acid suppressing power of PPIs often allows these other problems time to heal. He is also of the opinion that lifestyle and dietary changes are vitally important. He said that it is possible for GERD patients to “step down” to an H2-blocker (a different heartburn drug) after using PPIs for about a month and that, in conjunction with the dietary and lifestyle changes, these patients should be successful in managing their GERD.
He did acknowledge that there are “severe refluxers” who don’t have success stepping down from PPIs even with lifestyle and dietary changes. In those cases, he said that another option may be surgery to fix the underlying problem of the muscle weakness.
The study in which Dr. Al-Aly was a researcher examined medical records from over 1173,000 VA patients using prescription PPIs and over 20,000 patients using H2-blockers, such as Pepcid, Tagamet and Zantac, available both as prescriptions and over-the-counter. The study looked at five years of patient records and noted that 15% of PPI users were also diagnosed with CKD, while only 11% of those using H2-blockers developed CKD. The researchers weighed other factors and the study’s conclusion was that PPI users were at a 28% greater risk of developing CKD.
The risk increased the longer the patients used the PPIs. Those using the drugs for one to two years were three times more likely to develop kidney failure than were those who used PPIs for a month or less. It should be pointed out that less than 0.2% of the patients in the study developed end-stage kidney failure. However, the risk was almost doubled for those using PPIs.
Currently, Dr. Al-Aly and his team can only speculate as to how PPIs increase the risk of CKD. Other research indicates that PPI use is linked to acute kidney inflammation, however. Dr. Al-Aly said that it’s possible that kidney inflammation in some PPI users could go undiagnosed and ultimately lead to CKD.
PPIs can also cause magnesium deficiency, which could play a part in developing kidney disease. The mechanism behind the deficiency is the acid-blocking power of the drugs: with less stomach acid certain nutrients aren’t being properly absorbed.
Dr. Buckley added that there are several patients who use PPIs who never develop problems. He said that patients should be aware of the possible risks, though. And that, “They should also be aware we have really good alternatives.”
The study was released online April 14 in the Journal of the American Society of Nephrology.
SOURCES: Ziyad Al-Aly, M.D., associate chief of staff for research and education, Veterans Affairs Saint Louis Health Care System; F. Paul Buckley III, M.D., surgical director, Heartburn & Acid Reflux Center, Scott & White Clinic, Round Rock, Texas, and assistant professor, surgery, Texas A&M Health Science Center, Bryan, Texas; April 14, 2016, Journal of the American Society of Nephrology.
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