Heartburn, Acid Reflux Drugs Can Increase Risk of Kidney Stones, Chronic Kidney Disease

Medications commonly used to treat acid reflux, heartburn, and ulcers can cause damage to kidney function, a pair of recent studies revealed.

Proton pump inhibitors (PPIs) and histamine receptor-2 (H2) blockers, commonly used to reduce gastric acid production, can increase the risk of developing kidney stones and chronic kidney disease (CKD), according to research presented at ASN Kidney Week 2016 in Chicago, IL.

For the study, investigators obtained data on 187,330 participants from the Health Professionals Follow-up Study (HPFS) and Nurses’ Health Study (NHS) I and II, who did not initially have any kidney stones.

During a follow-up period of up to 12 years for PPIs and 26 years for H2 blockers, 3245 symptomatic kidney stones developed, according to the study.

The researchers adjusted for factors such as age, body mass index, comorbidities, race, physical activity, medication use, nutrient intake, and smoking status.

The results of the study showed the use of PPIs were associated with a 12% higher risk of developing a kidney stone, and use of H2 blockers was associated with a 13% higher risk.

A subgroup showed that the use of PPIs was associated with lower urinary excretion of calcium, citrate, magnesium, and oxalate, which are components of kidney stones, according to the study.

“Use of PPIs and H2 blockers is associated with a small increase in risk of incident kidney stones,” said Pietro Manuel Ferraro, MD, MS, PhD. “Further studies are needed to confirm our findings and to investigate whether the excess risk is related to a particular type of kidney stones such as those made of calcium oxalate.”

In the second study, researchers examined the current assumptions that chronic kidney disease, which may arise after use ofPPIs, is secondary to incomplete recovery from acute kidney injury (AKI).

Yan Xie, MPH, and colleagues, analyzed data on 152,157 users of PPIs or H2 blockers from the Department of Veterans Affairs national database.

The results of the study showed that PPI use was associated with a more than 30% higher risk of developing CKD or a combined endpoint of kidney failure, or more than a 50% decline in estimated glomerular filtration rate compared with H2 blocker use in the absence of AKI.

“Reliance on AKI as a marker of potential adverse renal events in those treated with PPI is not sufficient,” Xie said. “Exercising vigilance in PPI use — even in the absence of AKI – and careful attention to kidney function in PPI users may be a reasonable approach.”