Proton Pump Inhibitors Linked to Increased Risk of Kidney Stones

What Did the Research Discover?

This study investigated the association between proton pump inhibitor (PPI) use and kidney stone risk in U.S. adults using data from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. PPIs, commonly prescribed for acid-related conditions such as gastroesophageal reflux disease (GERD), ulcers, and Helicobacter pylori infections, have been linked to altered mineral absorption, which could contribute to kidney stone formation.

The study included 27,075 participants aged 20 and older, examining their PPI usage, history of kidney stones, and various health-related factors. Researchers performed logistic regression and subgroup analyses to determine the relationship between PPI use and both the occurrence and recurrence of kidney stones, adjusting for factors like age, sex, race, body mass index (BMI), and lifestyle habits.

The results revealed a significant association between PPI use and kidney stone risk:

• Individuals taking PPIs were 31% more likely to develop kidney stones than those who did not use PPIs.
• Each additional year of PPI use was linked to a 4% increase in kidney stone risk.
• PPI users also had a 49% higher risk of recurrent kidney stones, with a 7% increase in recurrence for each additional year of use.
• These associations remained significant even after conducting a propensity score matching analysis, which accounted for potential confounding factors.
• Subgroup analyses indicated that the effects of PPI use on kidney stone risk varied based on age, sex, race, and BMI, with stronger associations observed in older adults, females, non-Hispanic white individuals, and those with a BMI of 25 or higher.

How Can I Apply This Information?

For patients who use PPIs, these findings highlight the importance of evaluating long-term use and discussing alternative treatment options with healthcare providers. If PPIs are necessary, individuals should consider lifestyle modifications to lower kidney stone risk, such as staying hydrated, maintaining a balanced diet rich in calcium and citrate, and monitoring magnesium intake.

For healthcare providers, this study underscores the need for careful prescription practices, particularly for patients with pre-existing kidney conditions or a history of kidney stones. Physicians should consider periodic re-evaluation of PPI necessity and educate patients about potential kidney-related risks. Alternatives to long-term PPI use, such as H2-receptor antagonists (H2RAs) or lifestyle interventions, should be considered where appropriate.

For policymakers and healthcare systems, the study suggests that guidelines should emphasize the risks of long-term PPI use and encourage patient education about safer treatment durations. Given the widespread use of PPIs, integrating kidney function monitoring into routine care for long-term users could help mitigate risks.

While this study does not establish causation, it strengthens existing evidence that long-term PPI use may contribute to kidney stone formation and recurrence. Future research should focus on understanding the mechanisms behind this link, exploring how different PPI dosages, types, and treatment durations impact kidney health, and identifying safer strategies for acid-related disease management.

Source:

Liu W, Wang J, Wang M, Wang M, Liu M. Association of proton pump inhibitor use with risk of kidney stones: an analysis of cross-sectional data from the US National Health and Nutrition Examination Survey (2007–2018). BMJ open. 2023 Oct 1;13(10):e075136. https://pmc.ncbi.nlm.nih.gov/articles/PMC10582914/