According to new research, proton pump inhibitors (PPIs), commonly used to treat heartburn and acid reflux, may increase the risk for developing chronic kidney disease (CKD).  These findings will be presented at ASN Kidney Week 2015 November 3–8 in San Diego, CA.

In one study, Benjamin Lazarus, MBBS (Johns Hopkins University) and his colleagues followed 10,482 adults with normal kidney function from 1996–2011. They found that even after accounting for baseline differences, PPI users were 20–50% more likely to develop CKD than non-PPI users.  A second study, in which over 240,000 patients were followed from 1997–2014, revealed a similar finding. “In both studies, people who used a different class of medications to suppress stomach acid, known as H2-blockers, did not have a higher risk of developing kidney disease,” said Dr. Lazarus. “If we know the potential adverse effects of PPI medications we can design better interventions to reduce overuse.”

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In another study, Pradeep Arora, MD (SUNY, Buffalo) and his team found that among 24,149 patients who developed CKD between 2001 and 2008 (out of a total of 71,516 patients), 25.7% were treated with PPIs. Among the total group of patients, PPI use was associated with a 10% increased risk of CKD and a 76% increased risk of dying prematurely, however PPI users were less likely to have vascular disease, cancer, diabetes, hypertension, and chronic obstructive pulmonary disease.

“As a large number of patients are being treated with PPIs, health care providers need to be better educated about the potential side effects of these drugs, such as CKD,” said Dr. Arora. “PPIs are often prescribed outside of their approved uses, and it has been estimated that up to two-thirds of all people on PPIs do not have a verified indication for the drug.”

Proton pump inhibitors are among the top 10 class of prescribed medications in the U.S. They work by suppressing gastric acid secretion by specific inhibition of the H+/K+-ATPase in the gastric parietal cell. By acting specifically on the proton pump, these agents block the final step in acid production, thus reducing gastric acidity. 

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