New Information on PPIs and Chronic Kidney Disease

by Jennifer Mitchell Wilson B.S. Dietetics, Dietitian, Health Professional

More than 13 million Americans use PPI medications, which can stack up to as much as more than $10 million per year. With such a frequently used medication, easily accessed over the counter, is it realistic to think that each person is using it correctly?

Here's why it's so important to know how to safely use PPIs: More and more research has been showing that what was once thought to be a fairly harmless medication may have more risks than previously believed. One of the newest concerns involves the effect of PPIs on kidney function.** What does the newest study say about PPIs?**

A 2016 study of the Department of Veterans Affairs national databases and published in the Journal of the American Society of Nephrology showed a link between PPI use and Chronic Kidney Disease (CKD) as well as the progression to End Stage Renal Disease (ESRD). Comparing 20,270 new users of PPIs and 173,321 new users of H2 blockers, all with normal kidney function at baseline, researchers compared the risks of PPI and H2 blocker use.

What they found was that the PPI group was 28 percent more likely to develop CKD and 96 percent more likely to develop ESRD than patients in the H2-blocker group. They also found that those who used PPIs for more than 30 days also increased the risk proportionate to the additional use of the medication.

What do the kidneys do?

Critical to the proper function of the body, the kidneys remove toxins and waste products from the blood and maintain proper fluid, mineral and chemical balance. Hormones produced in the kidneys also stimulate red blood cell production, regulate blood pressure and control calcium metabolism.

Kidney disease and testing

According to the National Kidney Foundation, Chronic Kidney Disease (CKD) is defined as having an abnormality or marker, such as protein in the urine, for three or months or more. Excess protein can indicate that the kidneys are not filtering properly. Testing for kidney function generally involves a Albumin to Creatinine Ratio (ACR) test which estimates the amount of albumin, or protein, in the urine. Glomerular filtration rate (GFR) compares several lab tests with age, gender and race to come up with the most accurate index of overall kidney function. Results of these tests will play a role in your doctor’s assessment of your specific kidney function.

Proper testing: Things for acid reflux patients to consider

  • The most important thing to know is whether you actually have acid reflux. Only your physician can properly diagnose this condition. If you only have occasional heartburn your doctor may decide that it is better treated with antacids. This will avoid the risk of PPI use.

  • Do not self diagnose or treat with over the counter (OTC) PPI medications without talking with your physician first. Your doctor needs to be aware of every medication you are taking to compare with your medical history as well as your other medications.

  • Work with your doctor to limit additional risk factors for kidney disease like hypertension, diabetes, heart disease, smoking and high cholesterol.

  • If you have to be on PPIs for the long term treatment of acid reflux disease talk to your doctor about monitoring your kidney function. You may also want to discuss surgical options to treat chronic acid reflux disease that could reduce or eliminate the need for PPI medications.

Jennifer has a bachelor's degree in dietetics as well as graduate work in public health and nutrition. She has worked with families dealing with digestive disease, asthma and food allergies for the past 12 years. Jennifer also serves the Board of Directors for Pediatric Adolescent Gastroesophageal Reflux Association (PAGER).

Jennifer Mitchell Wilson
Meet Our Writer
Jennifer Mitchell Wilson

Jennifer Mitchell Wilson is a dietitian and mother of three girls. Two of her children have dealt with acid reflux disease, food allergies, migraines, and asthma. She has a Bachelor of Science in dietetics from Harding University and has done graduate work in public health and nutrition through Eastern Kentucky University. In addition to writing for HealthCentral, she does patient consults and serves on the Board of Directors for the Pediatric Adolescent Gastroesophageal Reflux Association.