Anti-reflux and acidity drugs are dangerous for the kidneys

Medications for frequent heartburn, acid reflux, and gastroesophageal reflux called proton pump inhibitors (PPIs) are some of the most prescribed medications in the world.

Given their prevalence, researchers from the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California, San Diego leveraged the FDA Adverse Effect Reporting System (FAERS) database to determine the unintended consequences of consuming PPI.

The study in the journal Scientific Reports, allowed the team to find that patients who took PPIs were more likely to develop kidney disease than those who took histamine-2 receptor antagonists. Another form of antacid that treats the same ailments.

“Post-marketing data collected by the FDA and deposited in the FAERS database allows us to search for potential adverse effects beyond what was found in a clinical trial, which may not have lasted as long. long or has not included as much diversity as FAERS,” said Ruben Abagyan, PhD, professor of pharmacy.

Increased risk of kidney failure

Common acid reflux medications are associated with an increased risk of kidney failure. The FAERS database contains more than 10 million patient records containing all voluntary reports of adverse reactions while taking a drug.

The research team focused on patients who were taking PPIs and no other drugs, which narrowed the study population down to around 43,000 patients. They applied a mathematical algorithm to look for statistically significant differences in reported kidney complications between patients who took PPIs and the control group, about 8,000 patients who took histamine-2 receptor blockers.

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Here’s what they found: Patients who took only PPIs reported a kidney-related adverse reaction at a frequency of 5.6%, compared to 0.7% in patients who took only histamine-2 receptor antagonists.

The team found that compared to the control group, patients who took only PPIs were 28.4 times more likely to report chronic kidney disease, as well as acute kidney injury (4.2 times more likely) , end-stage renal disease (35.5 times more likely), and unspecified renal disease (8 times more likely).

Patients who took PPIs were also more likely to experience electrolyte abnormalities, but this varied more between PPIs, while kidney-specific effects were the same for all five PPIs examined.

The teacher. Abagyan cautioned that this study does not reveal the absolute frequency of these kidney-related complaints for all people taking PPIs, since reporting in the FAERS system is voluntary.

He also says it’s possible, though unlikely, that the effect was due to unidentified confounders. A large, randomized, controlled clinical trial would be needed to definitively demonstrate causality between the use of PPIs and the absolute risk of renal failure in humans.

Necessary warnings, education and monitoring

As the World Health Organization points out, PPIs are essential medicines for many people, helping them to control symptoms that are often painful and disruptive to daily life.

However, Prof. Abagyan hopes these initial data will prompt healthcare providers to provide appropriate warnings, education and monitoring to patients who need PPIs, especially if they are already at high risk for kidney disease and electrolyte abnormalities.

The researchers made similar recommendations following a 2017 study by the San Diego School of Medicine at the University of California, San Diego, which found that PPIs promoted chronic liver disease in mice and humans.

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Tigran Makunts: Analysis of postmarketing safety data for proton-pump inhibitors reveals increased propensity for renal injury, electrolyte abnormalities, and nephrolithiasis. Scientific Reports volume


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