Antacids and Your Kidneys

Antacids and Your Kidneys

There are several medications that are commonly used for heartburn, or to treat ulcers, called antacids.
These include medications that neutralize stomach acid, and those that decrease production of stomach acid.

The medications that neutralize stomach acid include:
aluminum hydroxide and magnesium hydroxide
Carafate/Sucralfate: aluminum hydroxide
Amphojel: aluminum hydroxide

Aluminum can build up in patients with whose kidneys function at less than 30%, or stage 4 chronic kidney disease, as the kidneys cannot clear the aluminum.

Chronic aluminum toxicity causes bone and muscle pain, weak bones, anemia, and can eventually cause dementia as the aluminum builds up in the bones, affecting the bone marrow, and causing deposits in the brain.

Patients with stage 4 or 5 kidney disease, or who are on dialysis, should steer clear of antacids that contain aluminum.

The medications that decrease the production of stomach acid are of two classes, the H2 blockers and the proton pump inhibitors, or PPIs.

These medications are commonly prescribed for gastroesophageal reflux disease (GERD) where stomach acid refluxes, or backs up, into the esophagus. This causes the symptom we call heartburn, and in some patients, because the acid actually gets into the lungs, can cause asthma symptoms. They are also prescribed to heal ulcers, and for a condition called Barrett’s esophagus, where chronic reflux has damaged the lining of the esophagus, and causes a precancerous cells to grow in the esophagus.

The H2 blockers are:

The Proton Pump Inhibitors, or PPI’s are:

These classes of medications have been associated with inflammation in the kidneys, in the part of the kidney called the interstitium, the tissue in between the filtering units (glomeruli) and tubules. We call this interstitial nephritis, and this can be acute, causing the kidneys to quit functioning abruptly, or chronic, which causes gradual loss of kidney function.

Those who develop this complication with one class of acid blocker may not have this with the other class.

The H2 blockers and PPIs are available over the counter, so one can purchase them based on symptoms being experienced, which most commonly would be heartburn, or sometimes an upset stomach. In this case, these medications should not be used for more than a couple weeks. If your symptoms persist, you should see your physician to obtain a definite diagnosis, and determine if you should continue these medications.

Many patients take these medications for years, as they experience heartburn if they stop the medication. While the H2 blockers and PPIs are very effective at treating heartburn, they can, as noted above, cause acute and chronic kidney disease. In addition, because calcium is better absorbed in an acid environment, chronic use of these medications may cause calcium deficiency and osteoporosis. Studies have shown an increased risk of vertebral and wrist fractures in patients using these medications for many years.

For some patients, heartburn can be treated with lifestyle modification. This includes not eating for 2-3 hours before lying down to sleep, and keeping the head of the bed elevated 6-8 inches, using blocks to raise the head of the bed. For patients who are overweight, losing weight will reduce the intraabdominal pressure and reduce reflux symptoms. Some patients find certain foods trigger their heartburn, and avoiding these will help. Common food triggers include caffeine, chocolate, peppermint, fatty foods, spicy foods and carbonated beverages.

The H2 blockers and PPIs are also prescribed for stomach ulcers, as they help heal the lining of the stomach. In this case, they can usually be stopped after the stomach ulcer has healed.

Finally, H2 blockers and PPIs are prescribed for Barrett’s esophagus, and in this case, must be taken indefinitely, to protect the esophagus and prevent the development of cancer.

Patients with chronic kidney disease should consider treating their heartburn with lifestyle modification, rather than relying on the H2 blockers and PPIs to block acid production.

If prescribed these medications for an ulcer, ask your doctor when you can safely stop the medication.
Patients with Barrett’s esophagus will need to remain on an H2 blocker or PPI indefinitely, to lessen the risk of esophageal cancer.

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