Millions of people use proton pump inhibitors, or PPIs, to control heartburn and acid reflux.
These medicines reduce the amount of acid made by the stomach and can be very helpful for people with gastroesophageal reflux disease, also known as GERD.
Common PPIs include omeprazole, sold as Prilosec, esomeprazole, sold as Nexium, and lansoprazole, sold as Prevacid. Some are available without a prescription, which has helped make them among the most widely used medicines for stomach acid problems.
Researchers at the University of California San Diego examined whether these drugs might also be linked to kidney problems. Their study was published in the journal Scientific Reports in 2019.
The team used the U.S. Food and Drug Administration’s Adverse Event Reporting System, known as FAERS. This large database collects voluntary reports about health problems that happen while people are taking medicines.
The researchers focused on 42,537 reports involving people who used PPIs without other reported medicines. They compared them with 8,309 reports involving people who used another type of acid-reducing medicine called an H2 blocker, such as Pepcid or Zantac.
Kidney-related problems appeared much more often in the PPI reports. About 5.6% of the PPI reports included a kidney-related problem, compared with 0.7% of reports involving H2 blockers.
The differences were especially large for some serious conditions. Compared with the H2 blocker group, PPI users were about 28 times more likely to have chronic kidney disease reported and about four times more likely to have sudden kidney injury reported.
Reports of end-stage kidney disease were also much more common in the PPI group. Other reports included less specific kidney damage and kidney stones.
The researchers also found more reports of abnormal levels of important minerals and salts in the blood among PPI users. These included low magnesium, calcium, potassium, and sodium levels, although the pattern differed among individual PPI drugs.
These findings do not prove that PPIs directly cause kidney disease. FAERS is based on voluntary reports, so it cannot tell researchers how often these problems occur among everyone who takes the drugs, and other differences between patients may help explain some of the results.
This distinction is important because PPIs can provide major benefits when they are medically needed. They are commonly used for GERD, stomach ulcers, damage to the esophagus from stomach acid, and other conditions in which lowering acid can protect the digestive system.
The study instead adds to concerns about taking these medicines when they are not needed or continuing them longer than necessary. Earlier research has also found links between PPI use and kidney problems, although researchers continue to study how strong these risks are and which patients may be most vulnerable.
People taking a PPI should not suddenly stop a prescribed medicine because of this study. Stopping can cause acid symptoms to return, and some people need long-term treatment for important medical reasons.
Anyone who has been using a PPI for a long time can ask a doctor or pharmacist whether the medicine, dose, and length of treatment are still appropriate. People with existing kidney disease or other risk factors may also want to discuss whether kidney monitoring or another treatment is suitable.
For some people with mild reflux, changes such as avoiding meals close to bedtime, eating smaller portions, limiting foods that trigger symptoms, and maintaining a healthy weight may reduce symptoms. The best approach depends on the cause and severity of the person’s reflux.
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