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 While the side effect is extremely rare, and the study doesn't prove
the drugs cause kidney failure, the association is worrisome because
tens of millions of people a year take these pills, sold by
prescription and over-the-counter in some countries, with brand
names including Prilosec, Prevacid and Zegerid.
"Generally, the drugs are very well tolerated, and the vast majority
of patients who take them will not develop (kidney failure) or other
serious problems," lead study author Tony Antoniou, a researcher at
the Institute for Clinical Evaluative Sciences and St. Michael's
Hospital in Toronto, said by email. "But the drugs should be used
for the shortest possible duration."
Antoniou and colleagues identified about 290,000 people aged 66 or
older taking proton pump inhibitors in Ontario between 2002 and
2011, as well as a similar number of individuals not taking the
drugs.
The researchers then looked at how many people were hospitalized for
acute kidney injury within 120 days of starting treatment, and
compared that to the group not taking the drugs.
In an effort to capture only new users of the drugs, the researchers
excluded people from the study who had a prescription for these
medicines in the past year. They also excluded people diagnosed in
the past five years with illnesses linked to kidney failure such as
HIV and lupus. And, they barred people prescribed antibiotics within
the last four months because kidney failure can be caused by
infections or the drugs used to treat them.
Acute kidney injury occurred in 1,787 people, substantially less
than 1% of the total study population. People taking proton pump
inhibitors had a hospitalization rate of 13.49 per 1,000 persons per
year, compared with 5.46 per 1,000 without the drugs, according to
the results online April 16 in CMAJ Open.
"I would not restrict proton pump inhibitors based on this study
alone; the overall risk of (kidney failure) in the study population
was still quite low and the association with proton pump inhibitors
and renal injury is still only an association," said Dr. John
O'Brian Clarke, a gastroenterologist at the Johns Hopkins Hospital
in Baltimore.
Of all the possible side effects of these drugs, the most concerning
isn't kidney failure, it's osteoporosis, Clarke, who wasn't involved
in the study, said by email. There is also a risk that people won't
absorb certain vitamins and minerals such as magnesium, iron, B12
and calcium.
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"This study supports a growing body of literature to suggest that
proton pump inhibitor use is not risk-free," Clarke said.
"Clinicians should make every effort to restrict these agents only
to patients who truly need proton pump inhibitor therapy and to find
the minimum dose and duration of therapy necessary to treat their
issues."
While certain patients may be able to take antacids to relieve
symptoms of heartburn, proton pump inhibitors play an important role
in treating people with more serious medical problems, Dr. George
Sachs, a professor at the David Geffen School of Medicine at the
University of California, Los Angeles, said by email.
For patients with gastroesophageal reflux disease, or GERD, the
drugs can prevent the development of life-threatening esophageal
cancer, said Sachs, who wasn't involved in the study.
Patients should regularly review whether proton pump inhibitors are
necessary, said Antoniou.
"In many cases, lifestyle modifications (e.g. avoiding precipitating
foods, weight loss) may be all that are required," he said.
SOURCE: http://bit.ly/1J8lQ9a
CMAJ Open 2015.
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