Friday, November 6, 2015

Heartburn Drugs Tied to Kidney Disease

Proton pump inhibitors (PPIs) seem to be linked with an increased risk of chronic kidney disease, two new studies suggest.

Prilosec, Nexium and Prevacid belong to this class of drugs, which treat heartburn and acid reflux by lowering the amount of acid produced by the stomach.

While the current studies have shown as association between these drugs and the development of chronic kidney disease, they did not prove cause-and-effect relationship.

Still, the lead author of one of the studies believes, “It is very reasonable to assume that PPIs themselves can cause chronic kidney disease,” said Dr. Pradeep Arora, a nephrologist and associate professor at the SUNY Buffalo School of Medicine and Biomedical Science in Buffalo, N.Y.

“Patients should only use PPIs for [U.S. FDA] approved indications, and not to treat simple heartburn or [indigestion],” he cautioned.

Chronic kidney disease is increasing in the United States, with more than 20 million Americans now suffering with it, according to the American Society of Nephrology. This occurs when a person’s kidneys become damaged and can’t filer blood as they should. Diabetes and high blood pressure are two common risk factors for kidney disease, the society said.

Arora’s study involved more than 24,000 patient who developed chronic kidney disease between 2001 and 2008.

One out of the four of the kidney patients had been previously treated using a PPI. People taking a PPI also had nearly twice the risk of dying prematurely, the researchers found.

In the second study, researchers were led by Dr. Benjamin Lazarus from Royal Brisbane and Women’s Hospital in Australia, and Johns Hopkins University in Baltimore. They followed more than 10,000 adults with normal kidney function form 1996 to 2011.

They found that PPI users were up to 50% more likely to develop chronic kidney disease than non-PPI users, even after adjusting for differences between the two groups.

The researchers pointed out that people did not have a higher risk of chronic kidney disease if they used H2-blockers like Tagamet and Zantac.

My Take:
Critics of the studies claim that patients who take PPIs also tend to be obese and have other health problems such as diabetes, but the study did control for other health issues. However, the study did not initially account for NSAID (nonsteroidal anti-inflammatory drugs) use which have also been tied to chronic kidney disease.

The problem with both PPIs and NSAIDs are length of use. PPIs should be used for up to two weeks and NSAID use should be limited to 3 days. However, both classes of drugs are commonly prescribed for months or even years. We know that over 16,500 people a year die from taking NSAIDs but there are no such statistics for the PPIs.

The Bottom Line:
Please limit the use of these powerful drugs. They are designed for short term use only. If you are taking a PPI, ask you physician to prescribe an H2-blocker as an alternative, then gradually taper of it as well.

Source: October 27, 2015 National Institutes of Health

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