JAMA: Rx PPI use may be linked to chronic kidney disease

WASHINGTON — An article published Thursday by JAMA Internal Medicine online suggested proton pump inhibitors appear to be associated with an increased risk of chronic kidney disease but more research is needed to determine whether PPI use causes kidney damage.

 

Morgan Grams, of Johns Hopkins University, Baltimore, and coauthors quantified the association between PPI use and incident CKD in the general population using data on self-reported PPI use in the Atherosclerosis Risk in Communities study (10,482 participants followed up for a median of nearly 14 years) or an outpatient PPI prescription in the Geisinger Health System in Pennsylvania (248,751 participants followed up for a median of six years). 

 

A 10-year estimated absolute risk of CKD among 322 baseline PPI users was 11.8% while the expected risk had they not used PPIs was 8.5% across the ARIC study, Grams reeported.

 

In the replication group at Geisinger, the 10-year absolute risk of CKD among the 16,900 baseline PPI users was 15.6% and the expected risk had they not used PPIs was 13.9%.

 

"We note that our study is observational and does not provide evidence of causality," Grams acknowledged. "However, a causal relationship between PPI use and CKD could have a considerable public health effect given the widespread extent of use. More than 15 million Americans used prescription PPIs in 2013, costing more than $10 billion. Study findings suggest that up to 70% of these prescriptions are without indication and that 25% of long-term PPI users could discontinue therapy without developing symptoms. Indeed, there are already calls for the reduction of unnecessary use of PPIs." 

 

The study isn't relevant to the 14-day recommended use of over-the-counter PPIs in treatment of frequent heartburn, however. 

 

“Millions of consumers rely on safe and effective over-the-counter proton pump inhibitors to relieve frequent heartburn symptoms," the Consumer Healthcare Products Association responded. “It is important to note that the article published recently in the Journal of the American Medical Association Internal Medicine assessed possible association of chronic kidney disease and the long-term use of prescription PPIs. Currently available safety data as well as cumulative experience on the use of OTC PPIs does not warrant any revision of clinical practice or recommendations for use," the association added.

 

According to CHPA, the over-the-counter availability of PPI products provides an important health benefit to consumers and direct cost savings for the healthcare system. Previous research from CHPA and the Nielsen Company indicates 94% patient satisfaction with OTC heartburn medications and estimates that OTC therapy saves patients an average total of $174 each in office visits and medication costs annually.