How do PPI's "cause" kidney problems?

Digestive health
1

Ok, I must admit that I'm getting sick of the media reporting kidney problems due to long-term PPI’s. The Kidney problems arose when a study was released this year that might, again, might indicate that PPI’s were involved in causing the kidney’s to malfunction. If anyone wants to read the study and on how many people it has been conducted then refer to this link: http://www.ncbi.nlm.nih.gov/pubmed/26752337

Now I’m trying to figure out why and how would the PPI’s cause kidney problems??? When someone mentions dementia and PPI’s or Osteoporosis and PPI’s that makes sense because of the B12, calcium absorption respectively. But I can’t come up with the kidney problem. Could a vitamin, mineral etc. cause our kidney to function improperly?  If so, then OK, let’s increase the intake of these things and switch to H2 blockers for an amount of time for these things to get absorbed…

The part that I’m worried about is the organ interaction with the PPI chemistry. Is it possible and does anyone know how would the PPI’s (forget about the low stomach acid) affect our kidney due to numerous reports.

I’ m also getting sick of professionals talking about Kidney problems (YouTube, media, social networks etc.) whereas none of them specifies HOW could the PPI’S damage our kidneys, in what way, what should we do to prevent such thing if we are on PPI’s, basically, how to lower the risk of kidney failure whilst on PPI’s?. Instead of talking about how and why they are always, always talking about things that you can find out in a matter of seconds if you go and read about digestive problems.

I’ m 24 and been on PPI’s for 5 years now and will have to stay on them for the rest of my life so am worried about this things and would like to get an answer. Went for a blood test: iron, magnesium calcium are perfectly fine, went on a abdominal ultrasound, all organs are fine, went on a heart ultrasound, everything s fine. I’m on pantoprazole 40mg daily (morning 30-45 min before first meal).

By the way is 40mg pantoprazole a high dose (since you can’t get it OTC), does it leave some acid inside the stomach? (Barrett’s, gastritis, hiatal hernia which causes frequent belching and only PPI’s eliminate chest pain and stomach pain because of the GERD, gastritis).

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There has been far too much scaremongering about PPIs. Many of the published papers show correlations between collected data and the populist media doesn't seem to distinguish that from causation.

I had to include this page on my charity's website in an attempt to answer these inflated stoies and calm fears inflamed by sensationalism. https://sites.google.com/site/barrettswessex/treatment/drugs/ppi-dangers

A few days ago, I ran a survey with PPI users to see how many believed they had been adversely affected by PPIs. I received the 100 (maximum allowed free on survey monkey) within a few hours. The most common "side effect" was anaemia reported by just 17%. Two-thirds of the respondents had no side effects to report.

40mg pantoprazole is the stadard maintenance dose equivalent to 20mg omeprazole and 30mg lansoprazole.

3

Thank you Sir so much. I've read a huge amount of your posts (Quora, this site etc.). I also know that you’ve swallowed really big amounts of prazole pills.

The kidney stories are being spread by the media like hurricanes/tornadoes. Just go to Facebook and type in PPI’s or proton pump inhibitors and you’ll see only stories “Kidneys and PPI’s”.

I also know that people who have been on them 20+ years daily are still alive and still taking them and I found out that there are a pretty lot of this people out there. I’m now closing in with my 5 year on PPI. Altogether I’ve taken PPI’s daily maybe for a year or so rest of that time was Zantac (75-¸150mg). You previously said that this was a really low dose of an antacid and you were write because my stomach gets severely inflamed even if I take 150mg daily of a H2 blocker.

Also all the studies have been conducted on older people. As I can see younger people especially age under 30 have no really problems with them.

Would you know perhaps if 20mg ome or 40 mg pantoprazole leaves enough acid for digestion? If not then I’ll do my best and I’ll go to 20m panto/10mg ome OTC...

4

I am always a firm believer in what is the higher risk (an ulcer, cancer or side effect) and individual response.

When you read through studies, there is one thing in common re this statistic,

people who do react with a typical AIN (acute interstitial nephritis)

-easy to confirm with blood creatinine level elevation and symptoms-

and taking PPI,

that those often recover to full normal kidney function, once PPI is not taken anymore and therefore avoid a irreversible kidney failure.

Every page will tell you that it is unclear as to why the infiltration (of plasma cells and lymphocytes into the kidney tissue plus edema) happens,

it is just observed.

The kidney function with its filtration, reabsorbtion....is very complex.

Our whole body is a very complex chemical factory on a molecular basis.

Not everything is understood yet, how could it.

There is no way yet to understand as to why the chemical PPI, that has to be processed by liver (search metabolism of PPI)

and discharged by kidney is effecting the kidney of some in that way.

It is plain: unclear, but observed.

You simply need to watch out and as long as your kidney is fine with it, there is nothing against taking PPI.

But it also might mean, a doc has to check the blood creatinine level maybe more often than thought.

And when it goes up, better consider the PPI - if it had an impact - before it is too late.

(My daughter has started on high dose PPI with 14 and as things look will stay on it for a long time, my family members are on it for decades and one side effect was noted: multiple benign stomach polyps. )

I am not fed up with such studies, I am highly grateful not to overlook something possible like AIN caused by PPI. There is no need to stop taking PPI if your kidneys are fine with it. But it is good to know about it, not to ignore the possible - just possible- impact.

 

5

I agree with you at some point. But first let's make things clear. If you go to Google and search for „what causes kidney diseases “then you will find out that diabetes and high blood pressure are the main reasons listed by google. Also pain killers (which people take like candies) have a huge impact on kidneys. I’ve came across that magnesium depletion can cause kidney disease as well (that would explain the PPI’s).

Now, the study has been conducted on old people, I believe age 70+. Frankly, I don’t know any single person age 70+ in my community which does not take multiple drugs (especially for high blood pressure) almost every single day until they die.

I’ve to say that I’ve read thousands and thousands of post on the internet about long-term effects of PPI’s. There was maybe a <2% of people among all the posts (100%) mentioning something about having kidney issues. Now, all of a sudden you’ve got the Internet plagued with kidney stories and PPI’s.

I agree that all the data should be revealed to the public so that they are more prudent with these drugs and know the risks.

You are mentioning the “metabolism of PPI’s” that’s cool, but since it tackles the liver first why aren’t there LIVER horror stories complaints… but only kidneys.

I’m aware that these drugs aren’t 100% safe and that people should always seek for an alternative. There will always be individuals who will have major side effects (luckily few of them as I know) and also individuals who will have no side effects (even if taken for 30+ years, daily, in relatively high doses). Yes, our organisms are extremely complex and it’s hard to understand all the process but still doctors should give us a clue an insight (especially after 30 plus years in school and 10 years in practice) why would the PPI’s damage the kidneys.

I strongly believe that there is not a connection with Kidney’s and PPI’s and the reason is simple, again less than 2% of posts that I’ve read online have reported some kidney-PPI’s issues. That been said, I think the problem is: the drug interaction, of course old people-old organisms, hugely decreased levels of acid when people get old by the organism itself and taking PPI’s when you are in age leaves you almost 100% acid free, genetically predisposal of getting a kidney disease especially when you are in age etc. 

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6

There is a definite link between magnesium and the kidneys since one of their major functions is to rid th ebody of excess magnesium. Whether hypomagnesaemia can cause CKD or vice-versa, I wouldn't like to speculate.

I ran a survey via a facebook group a few days ago on perceived PPI problems. The limitations of the survey meant it was restricted to 100 respondents which was attained in a few hours.

I was expecting, due to the link's placement and from experience, that I would get more respondents who were "anti-PPIs" than those who were "pro-PPIs".

Out of the 100 respondents, only 4 thought they had kidney problems related to taking PPIs - though could offer no evidence of this. 6 thought they suffered from low magnesium but, again, no evidence (eg blood test results) were proffered in evidence.

I'm worried now. I'm very nearly 70 - and currently don't take any medication (though I did take PPIs for years prior to having a fundolication. ) smile

7

Liver is a complete different organ than kidney.

As you saw, liver works with a lot of different enzymes, kidneys do not (glomerular filtration etc). 

You can remove a lot of liver (3/4) and still function normal and it even grows back! (I had a liver resection, I saw what happened afterwards)

Remove 3/4 of kidney and you are in trouble and nothing regrows.

A healthy liver really copes with much more than healthy kidneys.

Maybe that's why, very different operation mode.

Kidney and liver cannot be compared by nature

as you can't compare brain to stomach or lungs to colon.

It doesn't surprise me at all in the big picture.

But I haven't studied organ physiology in detail (not my interest within med science field) or molecular level to answer on a molecular base.

I am happy to know that checking the creatinin sometimes is no mistake when taking PPI.

Of course people come in different shapes sizes diseases and still there is clear evidence, that some people with AIN and leaving just the PPI away (not other medication), reversed the AIN.

And that is really a good thing to know.

My family will keep on taking PPI, the study does not deter us or make us anxious at all. Maybe others are more hysteric about such studies.

I see the positive and know, nothing is the same for everyone.

8

Thank you all for the extra info. I see that you've studied some kind of medicine (unfortunately I'm an engineer and collect my knowledge through Internet posts and some short science papers). 

Apart from creatinine, what else should I check regarding the kidney's and how often should the blood check be done?

Answers to my question should have been provided with the results of the survey which exposed the PPIi's-kidney's association, but it seems that doctors just provide the results without safety measures which have to be taken when consuming PPI's long-term.

9

Well said,

I feel the same.

There is the 'hype' with xyz findings, not mentioned to differentiate as to which people were included in study and could relativate resulte, but worst: no solution given.

(I like a solution approach)

The solution is obviously not, to condemn PPI for each and everyone and live with ulcers and preventable cancers or misery.

How often to check for creatinine regarding PPI is nowhere outlined (at least I am blind. If you see it, let me know)

(search symptoms for AIN please. Pretty useless for us since my child is frequently vomiting, nausea, feverish and urinating within normal creatinine levels, but maybe useful for others)

Also note:

when one has a bacterial kidney infection creatinine goes up too since compromised in work, but once healed should be fine.

If you do regular exercise, build muscles and eat high protein/meat, creatinine can be higher. It's a muscle metabolism-by product after all, that needs to be flushed out. People even buy 'creatine' which is converted into creatinine in muscle....and then one has higher levels, duh. But within limits.)

With diabetes one should get creatinine checked once per year minimum.

(good blood flow is essential for kidney work, hence any disease effecting capillaries like untreated diabetes, or simple dehydration, heart conditions can also effect creatinine levels due to effecting kidneys' function, which makes sense due to pure physics of filtration and secretion.)

Every antibiotic, NAIDS effects the kidney, it seems to be an organ, that can only handle so much of incoming molecules to be flushed out, then crys with 'burn out' depending how old it is.

Of course living longer also means to outlive your renal function, organs do age. Especially kidneys.

Yes, there are a lot of factors playing together, hence I would not - like you said - put too much into PPI and kidney function studies since people on the one hand have other conditions, medications, too.

But it seems to be worth a try, once kidney plays up, to leave that part of medication like PPI away if possible and see, if kidney copes better with a rucksack with one item less to be burdened as they have proven to do with a big thank you and returning to work.

I think that's the essence we should take from the study. Just a reminder.

How often to check creatinine or GFR.....probably once or twice a year will do, like for diabetes. 

But it's nowhere to be found. Better watch out for AIN symptoms and get going for a check then additionally to a once a year check. (creatinine test or GFR are not expensive tests)

There is a good article about creatinine itself, the interpretation problems and how it works with creatinine and other renal parameters.

You are extremely good in reading studies and reading between the lines.

I post the link seperately in case it doesn't get approved.

We shall be fine.

Benefits outweigh risks though, always.

I think the study just wanted to prove, to be not careless about it.

Take care!

 

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http://www.mayomedicallaboratories.com/articles/communique/2008/11.html