A study conducted in the US by Dr Ziyad Al-Aly and published in the journal of American Society of Nephrology found that compared to people taking H-2 receptor blockers, those taking proton pump inhibitor drugs (PPI) are at a higher risk of developing serious kidney problems. The study concluded that a prolonged use of PPIs should be discouraged in patients.
The study was conducted in the Center of Clinical Epidemiology, VA Saint Louis Healthcare System, USA. The data was collected from the National Database of Department of Veterans Affairs. This data included the number of new users of PPI and the number of new users of H2 receptor blockers. 173,321 new users of PPI and 20,270 new users of H-2 receptor antagonists were selected and their renal functions were monitored for five years.
When the findings of the study for both user groups were compared, it was observed that new PPI users, who did not have any signs and symptoms of kidney disease previously, had 30 percent more chances to develop chronic kidney disease after five years in comparison with the other group. Similarly, the chances of serum creatinine level to get doubled and developing end stage renal disease in the PPI group was also observed to be very high.
The study further noted that a prolonged use of PPI among the users also increased the risks of developing renal diseases. This conclusion was strengthened by observing renal outcomes gradually among the users ranging from 31 to 720 days and comparing the results with the users who were exposed to PPI for less than 31 days.
It was recommended that H-2 receptor blockers, and not PPIs, should be the choice of treatment for prolonged use as they were relatively safer and have fewer chances of developing chronic kidney disease (CKD) and End Stage Renal Disease (ESRD). Similarly, if the administration with PPI to treat ulcers is unavoidable, it should be used for less than 31 days rather than for a prolonged use.
The corresponding author of the published study Dr Ziyad Al-Aly, MD, FASN, a Staff Nephrologist and an Associate Chief of Staff for Research and Education at VA Saint Louis Health Care System, said, “We suggest judicious use of PPIs, and that use is limited to when it is medically necessary and to the shortest duration possible.” He further stated that all the PPIs are over the counter (OTC) drugs, hence patients can indulge into self-medication for treating their GI problems. So it is recommended that these PPIs should be used only under the unavoidable circumstances and for a shorter period of time. He further advised the patients who often take PPI medications that they should consult their prescriber for replacement with other safe possible options.
It was observed during the study that the chances to develop end stage renal disease (ESRD) and failure of the kidneys in the patients who used PPIs was 96% more than in patients who used H-2 receptor blockers. Similarly, it was also observed that there was a decrease by 32% in the renal functions of the users using PPIs than those using H-2 receptor blockers. The risk of developing CKD was found to be 28% higher in PPI users than in H-2 receptor blocker users.
Dr David Juurlink MD, PhD, FRCPC, Professor at Sunnybrook Health Sciences Center, Toronto, Ontario, said, “All patients must realize that like all the other medications, the PPIs also have a higher risk. An over the counter status doesn’t mean that they are safe.” He also advised the patients who previously had normal kidney functions and now experiencing renal problems after the use of PPIs should consult their prescriber about the drug playing a part. He further said that there are very few chances of developing kidney problems with the use of H-2 receptor blockers as they are comparatively safer than PPIs. Although PPIs may lead to serious kidney problem, they are less effective than H-2 receptor antagonists. Moreover, he suggested that some modifications in the diet plan of the patients can also avoid the persistent use of the all ant-acid drugs.
PPIs include drugs like Omeprazole (Prilosec), Esomeprazole (Nexium), Lansoprazole (Prevacid), Pantoprazole (Protonix) and Rabiprazole (Aciphex). They are used for the treatment of peptic ulcers, conditions like heartburn and gastrointestinal reflux disease (GERD) and acid reflux, and are normally considered as the safest option. These agents act by decreasing the amount of acidic secretions of the stomach produced by acidic glands on the stomach lining. They do so by blocking the proton pump inside the stomach cells. The H-2 receptor blocker drugs include cimetidine (Tagamet), Nizatidine (Axid), Famotidine (Pepcid) and Ranitidine (Zantac). These agents are also indicated in GERD and gastrointestinal ulcers. These drugs decrease the gastric acid secretions by blocking the histamines at H-2 receptors which are present on the parietal cells of the gastric mucosa.
H-2 receptor antagonists may be considered as a safer option than proton pump inhibitors because of higher renal risks associated with the latter.