Association Between Heartburn Drugs & Chronic Kidney Disease Questioned

A recent article published in The Journal of Allergy and Clinical Immunology titled The “dangers” of chronic proton pump inhibitor use provides commentary on the relationship between use of proton pump inhibitors (PPIs)–such as Nexium, Prilosec, and Prevacid–and various side effects.

The authors of this study acknowledge the growing number of serious side effects that are reported to be associated with PPI use, and seek to whittle down the list to only those with the strongest association.

They ranked the reported side effects in terms of “observed effects,” “hypothesized effects (not observed),” and “reported weak association.”

As regards side effects that are the subject injuries of current lawsuits against the responsible drug manufacturers, the researchers ranked them as follows:

• Acute interstitial nephritis (AIN): observed effect
• Chronic kidney disease (CKD): reported weak association

While this article states that there is a “weak” association between CKD and PPI use, other studies would disagree.

One study in particular, Long-term kidney outcomes among users of proton pump inhibitors without intervening acute kidney injury, published in February of this year, provides the following information:

Proton pump inhibitor (PPI) use is associated with an increased risk of acute kidney injury (AKI), incident chronic kidney disease (CKD), and progression to end-stage renal disease (ESRD). PPI-associated CKD is presumed to be mediated by intervening AKI.

The goal of the study was to find out whether PPI use is associated with an increased risk of chronic renal outcomes in the absence of intervening AKI.

Based on their findings, they concluded that:

PPI use is associated with increased risk of chronic renal outcomes in the absence of intervening AKI. Hence, reliance on antecedent AKI as warning sign to guard against the risk of CKD among PPI users is not sufficient as a sole mitigation strategy.