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 Among hundreds of thousands of patients in Department of Veterans
Affairs (VA) databases, new users of PPIs without kidney disease
were 30 percent more likely to develop chronic kidney disease over
the course of five years. Their risk of kidney failure was doubled.
PPIs like Nexium and Prevacid are prescribed to treat ulcers,
heartburn and acid reflux and are some of the most effective forms
of treatment available, the study authors write in the Journal of
the American Society of Nephrology.
These drugs are generally viewed as safe and may be overprescribed
and continued for long periods without being necessary, they note.
“We suggest judicious use of PPI, and that use be limited to when it
is medically necessary and to the shortest duration possible,” said
senior author Dr. Ziyad Al-Aly, associate chief of staff for
research and education at the VA Saint Louis Health Care System.
The study team analyzed data in national VA databases on 20,270
people who had recently started taking PPIs. They compared this
group to 173,321 people who had started taking H2 blockers, a group
of drugs that reduce stomach acid by a different mechanism, blocking
histamines in the stomach.
All patients were free of kidney problems at the start, and were
followed for five years to see if their kidney function changed.
After adjusting for personal, social and economic factors as well as
health conditions that could influence kidney disease risk, the
study team found that people taking PPIs were at significantly
higher risk of new kidney problems compared to those taking H2
blockers.
The risk of a decline in kidney function was 32 percent higher for
people taking PPIs and the risk of new cases of chronic kidney
disease was 28 percent higher.
Patients taking PPIs were 96 percent more likely to experience
end-stage renal disease - kidney failure - than those who took H2
blockers.
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The risks also increased with the time that someone was taking PPIs,
leveling off after about two years of use.
Because many PPIs are available over the counter, people may take
them without the input of a doctor, Al-Aly said. He recommends
limiting the use of over the counter PPIs to only times when it is
necessary.
“If people find themselves taking over the counter PPI frequently,
then a doctor consultation is definitely needed to determine best
and safest options available to that patient,” Al-Aly told Reuters
Health by email.
H2 blockers are much less likely to cause kidney problems but often
aren't as effective as PPIs, said Dr. David Juurlink, a clinical
pharmacologist and drug safety researcher at the University of
Toronto, said by email.
“For many patients, dietary modification (less fat and alcohol)
would make acid-lowering drugs unnecessary and would impart other
long-term benefits as well,” said Juurlink, who was not involved in
the study.
“Patients should appreciate that, like all drugs, PPIs carry risk.
The fact that they're available over the counter doesn't mean
they're safe,” Juurlink said. “People who take PPIs and are later
found to have kidney problems should ask their physicians whether
the drugs might be playing a role,” he advised.
SOURCE: bit.ly/1StYOjm Journal of the American Society of
Nephrology, online April 14, 2016.
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