Kidney disease is a debilitating ailment that impacts around one in 10 Americans. There are multiple factors that can contribute to the development of kidney disease, and new research has linked some of those causes to certain pharmaceuticals, including proton pump inhibitors.
Healthy kidneys are crucial to the human body. These two bean-shaped internal organs clean the blood by filtering waste and extra water which leaves the body through urine. They also stabilize bodily levels of electrolytes, which are minerals that impact fluid levels, blood acidity, muscle operations and other processes. Additionally, the kidneys generate hormones that serve important functions such as keeping the bones strong.
When the kidneys suffer damage, excess fluid builds up in the body and lower extremities. This can cause swelling in the ankles. Nausea and vomiting often occur. Damaged kidneys cannot keep the blood clean, and the body deteriorates quickly. In fact, a person cannot survive for very long without functioning kidneys.
Kidney disease is a very serious condition, and the National Institute of Diabetes and Digestive and Kidney Diseases estimates that over 20 million Americans — which is one in 10 — suffer from some form of this condition.
Although kidney disease can happen to anyone, people over age 60 who have the following health issues are most at risk for developing it:
- High blood pressure
- Heart disease
- Family history of renal failure
- Peripheral artery disease
- Liver disease
Damage to the kidneys can either occur slowly over a period of many years, or suddenly after a specific illness such as a urinary tract infection. Chronic kidney disease (CKD) builds over a long period, while acute kidney injury (AKI) happens quickly, and is more likely to be reversible. Both forms can be fatal without proper treatment.
Luckily, people can reduce their risk of getting kidney disease by making lifestyle changes, checking their kidney health regularly and avoiding certain medications such as Tylenol (acetaminophen) and proton pump inhibitors if possible. Studies link these medications to kidney damage, and they should be used with caution in people at increased risk for kidney problems.
Kidney Disease Symptoms
Although kidney disease often causes noticeable symptoms, it may be mistaken for other illnesses. Chronic kidney disease and acute kidney injury share many of the same symptoms, but CKD often goes unnoticed. Sometimes it is not caught until it has become end-stage renal disease (ESRD), which is complete and permanent kidney failure.
The kidneys are durable organs and tend to adapt to changes when they take place over a long period of time. That is why doctors sometimes do not detect CKD in their patients until irreversible damage has been done. People whose kidneys have failed require dialysis or an organ transplant. Awareness of kidney disease symptoms and regular doctor visits can help people catch the illness before it worsens.
Some of the most common symptoms of early kidney disease are as follows:
- Decreased appetite
- Itching and dry skin
- Decreased or increased urine output
- Swelling of lower extremities
- Chest pain
- High blood pressure
- Unexplained weight loss
- High potassium levels
- Metabolic acidosis
A person with these more serious symptoms should see a doctor as soon as possible:
- Nausea and/or vomiting
- Trouble breathing
- Irregular menstrual periods
- Foul breath odor
- Frequent hiccups
- Abnormal thirst
- Blood in the stool
- Insomnia or sleep disturbances
- Skin shade changes
- Easy bruising
- Muscle cramps
- Decreased mental sharpness
Causes of Renal Failure
Acute kidney injury occurs following a specific event, such as a heart attack, an episode of heavy substance abuse, a urinary tract problem or a sudden decrease in blood flow to the kidneys. However, chronic kidney failure occurs over the course of months or even years.
The most common cause of chronic kidney failure is diabetes, followed by high blood pressure.
Other causes of kidney failure include:
- Urinary tract disorders
- Lupus and other autoimmune diseases
- Kidney stones and infection
- Drug abuse
- Polycystic kidney disease
- Nephrotic syndrome
- Some medications, such as proton pump inhibitors
- Trauma with blood loss
- Pregnancy complications
What many people might not realize is that certain medicines can also lead to kidney failure. This makes it even more important for patients to tell their doctors about all the medications they are taking and if they are at risk for kidney disease. Drug interactions may also pose a threat to these organs.
Drugs that Cause Kidney Damage
Since every substance that goes into the body is eventually passed through the kidneys, the organs can be damaged when they encounter harmful substances. There are a number of prescription and over-the-counter pharmaceuticals that can cause damage to the kidneys. Doctors often tell patients who already have kidney disease that these medicines should be avoided or used sparingly.
- Over-the-counter pain relievers — Heavy and long-term use of analgesic medicines such as ibuprofen and acetaminophen can cause or exacerbate chronic interstitial nephritis.
- Antihistamines — Benadryl and Unisom have both been linked to a form of kidney disease called rhabdomyolysis.
- Antimicrobials — Several antimicrobial medicines have been tied to multiple forms of kidney disease. For example, Cytovene has been tied to a form of kidney disease called crystal nephropathy.
- Benzodiazepines have been linked to rhabdomyolysis.
- Contrast dye — This substance is often used in lab testing and has been tied to a form of kidney disease called tubular cell toxicity.
However, these are not the only medications linked to the development of kidney disease. Research indicates a link between kidney disease and heartburn medications called proton pump inhibitors.
Kidney Damage Caused by Proton Pump Inhibitors
Proton pump inhibitors (PPIs) such as Prilosec, Prevacid and Nexium have been associated with renal failure. These drugs treat heartburn and acid reflux, and they are among the most commonly prescribed medications in the world. About 20 million Americans use them each year. The U.S. Food and Drug Administration (FDA) warns that usage of PPIs for one year or longer can lead to nutrient deficiencies and consequent bone density decreases that could lead to fractures.
Numerous studies also link these drugs to kidney disease. In fact, Dr. Cynthia A. Naughton of the North Dakota State University College of Pharmacy said that drugs, such as PPIs, cause 20 percent of AKI. Researchers are still seeking to explain the reason why, but one theory is that PPIs can lower levels of magnesium, a substance that is crucial to proper kidney function.
Interstitial nephritis is a form of kidney disease that has been linked to PPI usage. A 2015 study published by the Pharmaceutical Journal stated, “All PPIs are associated with acute interstitial nephritis.” A 2013 study published by BMC Nephrology looked at 184,480 PPIs users and found a positive association between renal disease and PPI usage, even after adjusting for other possible contributing factors. Specifically, patients with kidney disease were two times more likely to have used prescription PPIs in the past. Further studies into PPIs’ impact on the kidneys are in progress.
All usual symptoms of kidney disease apply to cases of PPI-induced disease. Doctors detect PPI-induced renal failure based on patients’ drug histories and the timeline of disease progression.
Some popular proton pump inhibitors include:
- Nexium (esomeprazole)
- Prilosec (omeprazole)
- Prevacid (lansoprazole)
- Dexilant (dexlansoprazole)
- Protonix (pantoprazole)
New Clinical Study Findings
In early 2016, a significant amount of research came out that linked PPI use to kidney disease. In April, researchers at the Veterans Affairs St. Louis Health Care System released a report showing that PPI users were more likely than those who used alternative heartburn medications to have CKD or ESRD within five years from the start of PPI usage. In January, a study published in the JAMA Network Journals stated that PPI users had a 15.9 percent risk of developing kidney disease over 10 years, whereas non-PPI users only had a 13.9 percent risk. Several academic and medical institutions are currently performing deeper research into this link.
Kidney Damage Lawsuits Related to PPI Usage
People who suffered kidney damage after taking PPIs are now filing lawsuits against drug makers. In 2016, a former PPI user sued drug manufacturer AstraZeneca after his kidneys failed, and he required a transplant. The plaintiff alleged that his use of AstraZeneca’s PPI led to his medical problems, and that the manufacturer purposefully withheld information about the possibility of consequent kidney problems. More lawsuits will arise as research continues to be released.
Since many kidney disease symptoms mimic those of other diseases, this illness can be difficult to spot. For this reason, doctors look at population risk factors in conjunction with exhibited symptoms. There are several populations that place some people at higher risk for kidney disease, such as:
- Those over age 60
- African Americans, Hispanics, Asians, Native Americans and Pacific Islanders
- Those whose close genetic relatives have kidney disease
If a doctor suspects possible kidney disease in a patient based on symptoms or risk factors, they will order testing. Two tests can confirm the presence or absence of kidney disease.
First, a blood test can detect glomerular filtration rates (GFR). This shows how much blood the kidneys are filtering every minute, and how well they are working. Ideally, people with healthy kidneys should show a GFR of 60 or higher. If a number below 60 is found, kidney disease may be present. The second way to detect kidney disease is by checking a patient’s albumin-to-creatinine ratio. This is done through a urine test, which detects the amount of protein present in a patient’s urine. When kidneys are damaged, there will be abnormally large amounts of protein in the urine.
For minor kidney damage, doctors recommend a healthy diet and exercise, and will keep a close eye on their patients’ kidney function. However, once ESRD has been reached, patients must receive significant and immediate treatment or they will die. There are several treatment avenues for renal failure patients, and each patient’s doctor can determine the best route.
Dialysis is a common treatment for kidney failure. This time-consuming and costly process is not a cure, but can improve quality and length of life, often adding 5–10 years to patients’ lives. There are two types of dialysis: hemodialysis and peritoneal dialysis.
Hemodialysis involves manual cleaning of the blood. It takes place 2–3 times per week, usually at at a medical facility, but some patients have hemodialysis systems in their homes. Patients are attached intravenously to a filtering machine for 3–4 hours while the blood passes through the machine and is cleaned of waste.
Peritoneal dialysis takes place daily at home with the patient awake or asleep. The length of sessions varies, but many patients choose to do it overnight. This process uses the patient’s abdominal cavity lining (or peritoneum) to clean the blood. A special liquid is injected into the peritoneum, and filters the blood through the many tiny blood vessels that exists in that area.
Doctors typically recommend kidney transplantation as a last resort. Since there are far fewer organs available than there are patients who need them, kidney transplant candidates must wait on a long list and receive dialysis in the meantime. When transplant candidates are chosen, they undergo a 3–4-hour surgery wherein their own kidneys are removed and replaced by a single donated kidney. Following a kidney transplant, patients usually remain in the hospital for at least one week, often longer. Unfortunately, even kidney transplants are not always successful, and sometimes a recipient’s body rejects the donated kidney. However, the vast majority of kidney transplants turn out well, and add years onto recipients’ lives. One month after surgery, about 97 percent of transplanted kidneys are working; 93 percent are working at the end of one year; 83 percent are still successful after three years.
Neither dialysis nor organ transplantation is inexpensive. Generally, insurance covers much of these costs, but out-of-pocket expenses can still be significant. The average total cost for a kidney transplant is $262,900, and the average annual cost for dialysis is $30,000. These figures do not account for lost work time, or the travel costs associated with regular dialysis sessions.
The federal government covers 80 percent of Americans’ dialysis costs, and the recipient and their insurance company must provide the rest. Most insurance companies cover 80 percent of kidney transplant costs, and leave the remaining 20 percent to the patient. This means that the average American who received a kidney transplant must pay over $50,000 in out-of-pocket medical expenses.
Although kidney disease is not always preventable, steps can be taken to decrease its chances of development. A person with diabetes or high blood pressure should manage those ailments in accordance with their doctor’s instructions. Those with a family history of kidney failure should regularly remind their doctors to check in on their kidney function.
Regardless of kidney function status, everyone can help ward off kidney disease by maintaining a healthy diet and active lifestyle through the following:
- Exercising regularly
- Avoiding excessive dietary fat, cholesterol, salt and sugar
- Eliminating tobacco use
Living with Kidney Failure
Although kidney failure is devastating, it can be managed with proper medical care and healthful habits. Even in those with ESRD, kidney disease survival rates have slowly climbed over the past several decades. Organ grafts and dialysis treatments are continuously becoming more sophisticated, and doctors understand more about the progression of the disease.
Doctors usually make the following lifestyle recommendations to patients experiencing kidney failure:
- Keep an eye on cholesterol levels and blood pressure
- Take medicines as prescribed
- Stop smoking, if applicable
- Avoid alcohol
- Get adequate exercise
- Maintain or achieve a healthy weight
- If diabetic, control blood sugar
Regardless of how each case of the cause of kidney disease, it is a detrimental yet manageable disease. When kidney failure has been caused by medications such as PPIs, patients may seek legal remedies. As additional research is conducted into the link between PPI usage and kidney disease, more lawsuits may be filed by people who suffered kidney damage after taking these medications.