Docs: Prolonged use of antacids harms kidneys
Rupalil.Mukherjee@timesgroup.com 10.04.2018
Mumbai: Recent global studies suggesting that prolonged use of widely prescribed antiacidity pills to treat “gas” and heartburn may be linked to long-term kidney damage, acute renal disease and chronic kidney disease have sparked fresh debate amongst the medical community here.
Though a few initial reports about the association of these drugs — also called PPIs (proton pump inhibitors) — with kidney disease have been published in reputed medical journals over the last couple of years, it is only now that there are studies suggesting that it’s more serious and linked to both acute kidney injury and chronic kidney disease, doctors told TOI.
Also, since these reports are mostly restricted to nephrology journals and limited to only specialists, many physicians may not be really aware of these adverse effects.
Acidity pills should be prescribed for less than 8 weeks
Increasing concerns about these drugs could be the reason why their safety profile was discussed at the Annual Conference of Nephrologists and a conference of the Association of Physicians of India.
PPIs rank among the top 10 prescribed classes of drugs and are commonly used to treat acid reflux, indigestion, and peptic ulcers. They are prescribed across specialities, from orthopaedics and cardiology to internal medicine and surgery.
A US-based nephrologist, Dr Pradeep Arora, spoke about the drug’s risks at the annual conference of the Indian Society of Nephrology in Delhi recently. He told TOI: “PPIs should be ideally prescribed in the approved indications, if possible for less than eight weeks. Beyond this, if a patient is on PPIs, kidney function and magnesium levels need monitoring.”
Most patients do not know about side-effects like CKD (chronic kidney disease) as in the early stages CKD from any cause usually shows no symptom. Therefore, it is essential to use PPIs only for specific indications, and not for a prolonged time, as well as monitor kidney function during its usage, said Vijay Kher, chairman, nephrology, at Delhibased Fortis Escorts.
When PPIs for tacking acidity first hit the market nearly 20 years ago, they were perceived as very safe. This perception perhaps still lingers amongst a large section of gastroenterologists, physicians and other specialists and has percolated down to patients as well.
Since these drugs suppress acids, they could be responsible for adverse effects like iron absorption, vitamin D3 and B12 deficiencies, electrolyte imbalances (low magnesium), infections in the GI tract, etc. Studies indicate that the risks for the elderly could include heart problems and dementia.
“Recent studies say indefinite use of these medicines leads to kidney problems — like among the young there is a small increased risk of acute kidney injury, and among elderly, chronic kidney disease. There should not be indefinite use of these drugs,” said Dr Gourdas Choudhuri, director & HoD, department of gastrointestinal and hepatobiliary sciences at Fortis Memorial Research Institute.
“It is important to be careful when prescribing PPIs, especially in those at risk of kidney dysfunction (for instance, a patient with diabetes). In these patients, kidney function should be carefully monitored,” said Delhi-based diabetologist Dr Anoop Misra.
Though no advisory has been issued against the medicine, Dr Kher said drug regulatory authorities will be informed.
Rupalil.Mukherjee@timesgroup.com 10.04.2018
Mumbai: Recent global studies suggesting that prolonged use of widely prescribed antiacidity pills to treat “gas” and heartburn may be linked to long-term kidney damage, acute renal disease and chronic kidney disease have sparked fresh debate amongst the medical community here.
Though a few initial reports about the association of these drugs — also called PPIs (proton pump inhibitors) — with kidney disease have been published in reputed medical journals over the last couple of years, it is only now that there are studies suggesting that it’s more serious and linked to both acute kidney injury and chronic kidney disease, doctors told TOI.
Also, since these reports are mostly restricted to nephrology journals and limited to only specialists, many physicians may not be really aware of these adverse effects.
Acidity pills should be prescribed for less than 8 weeks
Increasing concerns about these drugs could be the reason why their safety profile was discussed at the Annual Conference of Nephrologists and a conference of the Association of Physicians of India.
PPIs rank among the top 10 prescribed classes of drugs and are commonly used to treat acid reflux, indigestion, and peptic ulcers. They are prescribed across specialities, from orthopaedics and cardiology to internal medicine and surgery.
A US-based nephrologist, Dr Pradeep Arora, spoke about the drug’s risks at the annual conference of the Indian Society of Nephrology in Delhi recently. He told TOI: “PPIs should be ideally prescribed in the approved indications, if possible for less than eight weeks. Beyond this, if a patient is on PPIs, kidney function and magnesium levels need monitoring.”
Most patients do not know about side-effects like CKD (chronic kidney disease) as in the early stages CKD from any cause usually shows no symptom. Therefore, it is essential to use PPIs only for specific indications, and not for a prolonged time, as well as monitor kidney function during its usage, said Vijay Kher, chairman, nephrology, at Delhibased Fortis Escorts.
When PPIs for tacking acidity first hit the market nearly 20 years ago, they were perceived as very safe. This perception perhaps still lingers amongst a large section of gastroenterologists, physicians and other specialists and has percolated down to patients as well.
Since these drugs suppress acids, they could be responsible for adverse effects like iron absorption, vitamin D3 and B12 deficiencies, electrolyte imbalances (low magnesium), infections in the GI tract, etc. Studies indicate that the risks for the elderly could include heart problems and dementia.
“Recent studies say indefinite use of these medicines leads to kidney problems — like among the young there is a small increased risk of acute kidney injury, and among elderly, chronic kidney disease. There should not be indefinite use of these drugs,” said Dr Gourdas Choudhuri, director & HoD, department of gastrointestinal and hepatobiliary sciences at Fortis Memorial Research Institute.
“It is important to be careful when prescribing PPIs, especially in those at risk of kidney dysfunction (for instance, a patient with diabetes). In these patients, kidney function should be carefully monitored,” said Delhi-based diabetologist Dr Anoop Misra.
Though no advisory has been issued against the medicine, Dr Kher said drug regulatory authorities will be informed.
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