Popular heartburn drugs linked to gradual, “silent” kidney damage

It’s well-known that taking proton pump inhibitors (PPIs) for extended periods may lead to serious damage of the kidneys. These popular drugs–sold under brand names such as Nexium, Protonix and Prilosec–can lead to acute damage of the kidneys, including total renal failure.

However, only recently was it discovered that kidney damage may occur gradually, with no signs until kidney damage has significantly progressed. This is according to researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System.

Typically doctors look for acute kidney issues to determine if there is a decline in kidney function. In other words, they rely on a sudden onset of symptoms as an indicator that harm is being done to the kidneys, and then provide a medical intervention. However, the study–published in the Feb 2019 edition of Kidney International–showed that of 125,000 patients on PPIs, over half developed kidney damage with no symptoms beforehand, and thus were not aware of the diminishing function of their kidneys.

According to the study’s senior author, Ziyad Al-Aly, MD, patients on PPIs should be monitored closely for kidney issues even when no apparent symptoms are present, as they may be experiencing a decline in kidney function. This decline can occur “silently” and over a long period of time, potentially leading to long-term kidney damage or even complete renal failure.

This issue is compounded by the fact that PPIs are widely available over-the-counter, and individuals with chronic acid reflux or may be using them long-term without being in under a doctor’s care. The often highly effective for treating gastrointestinal reflux disease (GERD), these drugs have come under heavy scrutinity for potential damaging effects to health. Indeed, a 2017 review of the relevant literature cited PPIs as being associated with kidney disease, vitamin deficiency, dementia and osteoporosis, among other side effects.

Xie, Yan; Bowe, Benjamin; Li, Tingting; Xian, Hong; Yan, Yan; and Al-Aly, Ziyad, ,”Long-term kidney outcomes among users of proton pump inhibitors without intervening acute kidney injury.” Kidney international.91,6. 1482-1494. (2017). 

Maes ML, Fixen DR, Linnebur SA. Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence. Ther Adv Drug Saf. 2017;8(9):273-297.