Proton pump inhibitors are drugs used for stomach conditions like ulcers and gastroesophageal reflux. They’ve also been associated with kidney failure.

All drugs, both over the counter and prescription, have potential side effects. For example, some drugs may affect your kidneys and can lead to kidney failure.

Proton pump inhibitors (PPIs), a common drug type used for gastroesophageal reflux disease (GERD) and other health conditions, are one such drug type. Keep reading to learn more about how PPIs affect your kidneys.

What are proton pump inhibitors?

PPIs are a type of drug that’s often used to treat GERD, a condition where your stomach contents come up into your esophagus (the tube that connects your throat to your stomach). These drugs are also used to treat other conditions like stomach ulcers and Helicobacter pylori infection.

On a basic level, PPIs work by decreasing your production of stomach acid. This in turn reduces symptoms like heartburn and abdominal discomfort.

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PPIs have been associated with both acute kidney injury (AKI) and chronic kidney disease (CKD). Let’s look at each in more detail.

Acute kidney injury

AKI is when kidney failure happens suddenly over a period of hours or days. AKI due to PPIs typically happens because of interstitial nephritis.

Interstitial nephritis is when the space between your kidneys’ tubules becomes inflamed. Inflammation around your tubules can interfere with your kidneys’ ability to effectively filter your blood.

Drug reactions are the most common cause of interstitial nephritis. This is when your immune system reacts to the drug, leading to tissue damage. In the case of interstitial nephritis, the damage is limited to your kidney.

Studies have found that people using PPIs are at an increased risk of interstitial nephritis and AKI. It’s also important to note that people who’ve experienced AKI are at an increased risk of having it again or developing CKD.

Chronic kidney disease

CKD progresses more slowly, typically over a period of years. The Centers for Disease Control and Prevention (CDC) estimates that 15% of adults in the United States have CKD.

A 2016 cohort study linked PPI use with a 20% to 50% higher risk of CKD. The same association wasn’t observed with H2 receptor blockers, another common drug type for GERD.

AKI can increase your risk of developing CKD in the future. As such, one idea of how PPIs contribute to CKD is through a previous AKI.

Despite this, some studies have found an increased risk of CKD in people using PPIs who had no previous history of AKI. This suggests that PPIs can damage your kidneys through another mechanism. What this could be isn’t yet known.

Several studies have also linked PPI use with an increased risk of progression of existing CKD. But not all research has supported these findings.

PPIs in people with existing CKD

Some research has found that PPIs are still used frequently across all CKD stages.

If you have CKD and are prescribed PPIs, talk with a doctor or healthcare professional about the potential risks associated with them and how they may impact your individual situation.

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AKI and CKD have been reported with all PPIs. There are six PPIs that are currently approved by the Food and Drug Administration (FDA). These are:

A 2021 study found that dexlansoprazole, followed by lansoprazole, had the strongest safety signal for both AKI and CKD. This generally means that these drugs were more likely to cause kidney issues.

Meanwhile, rabeprazole and omeprazole had the lowest signals for AKI and CKD, respectively. This means they were the least likely to lead to these types of kidney conditions.

How long does it take a PPI to cause issues?

The same 2021 study discussed above noted that the median time from PPI use to reported kidney issues was 23 days for AKI and 177 days for CKD.

A 2018 study found that the risk of CKD increased with higher PPI doses. It also noted that the risk of CKD increased after 3 months of exposure to PPIs.

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For most individuals, PPIs are safe and effective when used under a doctor’s supervision. The only solid reason you shouldn’t take PPIs is if you have a history of allergic reactions to them.

Because PPIs are processed by your liver, they need to be used with caution in people with severe liver disease.

PPIs can also interact with other drugs processed by your liver. When this happens, it can increase or decrease the amounts of these drugs in your bloodstream. A few examples of drugs that interact with PPIs in this way are:

Because they affect your production of stomach acid, don’t use PPIs with drugs that require a certain pH level in order to be absorbed. Examples include:

If PPIs cause kidney issues, a doctor will take you off of them. It’s possible that another type of drug, such as an H2 receptor blocker may be prescribed to treat your GERD symptoms instead.

Typically, once kidney damage has occurred, it can’t be reversed. But kidney damage can be reduced when it’s detected and treated early.

Symptoms of kidney damage

It’s important to be aware of symptoms that may be PPIs affecting your kidneys and to see a doctor if they occur. These include:

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Some of the common side effects of PPIs include:

Other potential adverse effects associated with PPIs are:

PPIs are a common type of drug that’s used for GERD and stomach ulcers. PPIs have also been associated with both AKI and CKD.

AKI due to PPIs often happens due to interstitial nephritis, where your immune system reacts to a drug. The mechanism behind how PPIs are associated with CKD is less clear.

If you’re prescribed PPIs and have concerns about kidney problems or other adverse effects, have an open conversation with a doctor. They’ll be able to address any questions or concerns that you may have.