PPI Use Linked to Chronic Kidney Disease

Acid-suppressing drugs called proton pump inhibitors or PPIs are considered so safe that they can be purchased over the counter as Nexium, Prevacid and Prilosec. House brands include esomeprazole, lansoprazole and omeprazole. The first PPI approved by the FDA was Prilosec (omeprazole) in 1989. At that time it was available only with a physician’s prescription. It was considered very safe. No one was thinking that chronic kidney disease could be a possible complication of PPIs 30+ years ago.

These drugs were originally intended to treat ulcers of the stomach or upper intestine. They were then used to ease symptoms of gastroesophageal reflux disease (GERD). Because the primary symptom of this condition is heartburn, their use has been widely expanded to treat heartburn and other signs of digestive distress.

Consequences of PPI Use:

Two studies presented at an annual conference for doctors treating kidney problems indicate that regular use of such medications can increase the likelihood of developing chronic kidney disease. In one study of 10,000 individuals, those taking a PPI were 20 to 50 percent more likely to develop chronic kidney disease over fifteen years.

The other study included more than 240,000 people followed for 17 years. They, too, were more susceptible to chronic kidney disease if they were taking a PPI, but not if they took cimetidine (Tagamet) or ranitidine (Zantac), unrelated drugs that treat similar digestive problems.

This research was presented at the ASN (American Society of Nephrology) Kidney Week, Nov. 3-8, 2015.

Fast Forward to August 20, 2025 – Omeprazole and Chronic Kidney Disease:

Researchers accessed data from the FDA’s Adverse Event Reporting System (FAERS). They published their findings in PLoS One (Aug. 20, 2025):

“Notably, renal [kidney] and urinary disorders showed strong positive signals, including chronic kidney disease, acute kidney injury, and renal failure, with statistically significant disproportionality measures.”

The authors list the following case reports in the FDA’s database:

• Chronic Kidney Disease: 28,639
• Acute Kidney Injury:        15,935
• Renal Failure:                    13,224
• End Stage Renal Disease  8,516
• Renal Injury                        8,208

The authors report:

“…it is noteworthy that omeprazole-induced PTs [preferred terms] related to the renal and urinary disorders warrant significant attention. These renal-related PTs, such as chronic kidney disease, acute kidney injury, renal failure and end stage renal disease, are largely unmentioned in the drug product labels.”

Chronic Kidney Disease:

Chronic kidney disease usually develops gradually, as the kidneys lose their ability to function well. It may lead to anemia, high blood pressure, neuropathy and cardiovascular complications. Unfortunately, the symptoms are not very specific: fatigue, poor appetite, trouble concentrating, difficulty sleeping, nighttime muscle cramps and dry, itchy skin. It can be diagnosed from a blood test.

Chronic kidney disease is just the latest in a long list of serious complications associated with PPIs. Problems such as pneumonia, intestinal infections with C. diff bacteria, an increased risk of weakened bones and fractures and a greater propensity for heart attacks makes one wonder whether the benefits of these heartburn medicines outweigh the risks for long-term treatment. People taking them without a prescription don’t have the benefits of medical supervision.

A reader reports a case of chronic kidney disease:

Most people cannot relate to something that seems abstract, like kidney damage. That is why case stories can be powerful. Here is one we received:

Q. I was prescribed omeprazole for 25 years. Out of the blue, with no other risk factors, I was diagnosed four years ago with stage 3 kidney disease.

I was treated for the kidney disease with immunosuppressant drugs and have been in remission for three years. When I mentioned that proton pump inhibitors like omeprazole have been linked to kidney problems, my nephrologist rolled his eyes. I still believe it was the cause of my condition.

A. A systematic review of proton pump inhibitors (PPIs) such as omeprazole concluded: “PPIs are associated with the development of CKD” [chronic kidney disease] (Cureus, Dec. 3, 2023).

Problems Stopping PPIs:

It can, however, be difficult for patients to discontinue these medications. A person who stops one suddenly may experience rebound hyperacidity with heartburn worse than the initial symptoms for which the drugs were given. The hyperacidity can last up to six weeks, and not everyone finds they have the strength to endure the severe discomfort for that long. That is why we offer some alternatives in our Guide to Digestive Disorders to help people get off a PPI when it is time to discontinue it.

If you have found this article of interest, please make it available to those you think might benefit from this worrisome complication of proton pump inhibitors. Thank you for supporting our work.