Proton Pump Inhibitors and Kidney Disease

Proton Pump Inhibitors and Kidney Disease

The prevalence of chronic kidney disease is increasing, with more than 20 million Americans affected by the disease. While it is well known that diabetes and hypertension are common risk factors, certain medications can also play a role and may be contributing to the epidemic.

According to two new studies that were just presented this past week at ASN (American Society of Nephrology) Kidney Week 2015 in San Diego, CA (November 3-8), certain acid reflux medications may have harmful effects on the kidneys. These types of medications, also known as proton pump inhibitors or PPIs, are among the top 10 prescribed medications in the United States.

In the first study, researchers from Johns Hopkins University followed 10,482 adults with normal kidney function from 1996 to 2011. They found that patients taking proton pump inhibitors were 20% to 50% more likely to develop kidney disease than patients not on these medications. These finding were not seen in patients using H2-blockers to suppress stomach acid.

In the second study, researchers from SUNY in Buffalo, NY found that among 24,149 patients who developed chronic kidney disease between 2001 and 2008, 25.7% were treated with PPIs. According to the study, those who took PPIs were less likely to have vascular disease, cancer, diabetes, hypertension, and COPD, but PPI use was linked to a 10% increased risk of chronic kidney disease and a 76% increased risk of dying prematurely.

If we know the potential adverse effects of PPI medications, we can look at better alternatives to avoid the risk of chronic kidney disease and reduce their overuse.

Pharmaceutical interventions may provide symptom management but they do not correct many of the underlying factors, and many have side effects. Lifestyle changes and nutritional support are usually sufficient to address acid reflux. Patients should be encouraged to eat smaller portions at mealtime. They should also avoid laying down after meals and eating too close to bedtime. Alcohol and specific foods can trigger symptoms, so it is beneficial to identify and eliminate these problematic areas.

Although these medications may help with the symptoms, proton pump inhibitors may not be the solution. We typically do not produce more hormones, insulin, and enzymes as we age. The truth is that most of our bodies’ processes decrease as we age. Most people suffering with acid reflux or GERD commonly are suffering from hypochlorhydria, which is when the stomach is unable to produce enough hydrochloric acid. Hypochlorhydria can lead to other problems such as small intestinal bacterial overgrowth (SIBO).

Nutritional supplementation may be beneficial to help improve digestive function, such as probiotics and glutamine. Deglycyrrhizinated licorice (DGL) is well established as an anti-ulcer and mucosal healing botanical, and is soothing and protecting to the gastric mucosa and mucous membranes lining the digestive tract.

Helicobacter pylori is a major cause of gastritis. Mastic gum, methylmethionesulfonium, zinc-carnosine and vitamin C address both eradication of H. pylori and the healing and protection of inflamed mucosal tissue.

These alternative approaches are typically more effective than what is provided by proton pump inhibitors and do not have side effects or other complications that may accompany PPI use, such as mineral deficiencies, bacterial infections, and dysbiosis.


Proton Pump Inhibitor Use Is Associated with Incident Chronic Kidney Disease Benjamin Lazarus, Yuan Chen, Francis Perry Wilson, Josef Coresh, Morgan Grams. Johns Hopkins Univ, Baltimore, MD; Royal Brisbane and Women’s Hospital, Queensland, Australia; Yale Univ School of Medicine, New Haven, CT.

Proton Pump Inhibitors Are Associated with Increased Risk of Development of Chronic Kidney Disease Pradeep Arora, Mojgan Golzy, Anu Gupta, Rajiv Ranjan, Randy L. Carter, James W. Lohr. Nephrology, VA Medical Center, Buffalo, NY; Medicine, SUNY, Buffalo, NY; Dept of Biostatistics, UB, Buffalo, NY.