What's the Link Between Acid Reflux and Kidney Disease?

Acid reflux is what happens sometimes after having certain foods or drinks -- especially after indulging in greasy, fatty or spicy foods. Stomach acid goes up toward the esophagus, which is the tube in your digestive system connecting the throat and stomach. If you have acid reflux, you'll feel a burning sensation in your chest. That unpleasant burning sensation may feel worse at night, when you're lying down. Acid reflux also can cause a bitter taste in your mouth.

Acid reflux is also called heartburn or acid indigestion. A more severe form of acid reflux is called GERD, which is short for gastroesophageal reflux disease.

Acid reflux is very common. In fact, more than 60 million Americans have acid reflux at some point, according to the American College of Gastroenterology. There may be as many as 15 million Americans who experience acid reflux daily, the ACG reports.

Reflux Medications

There are specific types of medicines to help treat acid reflux. These include a class of medicines called proton pump inhibitors. Some examples of PPIs available over-the-counter include:

-- Esomeprazole.

-- Omeprazole.

-- Lansoprazole.

There's also a type of medication called H2 blockers available over-the-counter to help with acid reflux. These include:

-- Cimetidine.

-- Famotidine.

-- Nizatidine.

-- Ranitidine.

If you've ever had acid reflux, then you know how unpleasant it can feel. That may lead you to wonder if having certain diseases, including kidney disease, increase your chances of developing acid reflux.

[See: 10 Tips for Avoiding Acid Reflux.]

Can Kidney Disease Cause Acid Reflux?

Although acid reflux may be more common among those with kidney disease, there's no proven link between kidney disease and an increased risk of acid reflux. "It has yet to be established that kidney disease itself causes GERD," says gastroenterologist Dr. Jason R. Rubinov, a clinical instructor of medicine at the Icahn School of Medicine at Mount Sinai in New York and medical director of the Gastroenterology Center of New York.

It's possible that there's a link because the kidneys aren't functioning properly in people who have chronic kidney disease, Rubinov says. Because of improper kidney function, a hormone called gastrin, which is released by the stomach, can't be cleared from the stomach properly. This can cause levels of gastrin to be higher, he explains.

"As a result, the acid-secreting cells of the stomach are hyper-stimulated, leading to increased acid secretion and decreased stomach pH," Rubinov says. A low pH, which measures how acidic or basic something is, means that it's acidic. This could create an environment for worsening acid reflux.

Additionally, many people with kidney disease have other factors that may increase their chances of having acid reflux, says Dr. Deepak Malhotra, chief of the division of nephrology at the University of Toledo College of Medicine and Life Sciences and the University of Toledo Medical Center in Toledo, Ohio.

These include:

-- Being obese.

-- Having diabetes.

-- Being older.

"Both obesity and uncontrolled blood sugar can worsen a patient's acid reflux symptoms by increasing abdominal pressure on the stomach and altering gastric motility," Rubinov says. Gastric motility refers to your stomach's ability to process food and move it on to the intestines. This is part of the normal digestion process.

If you already have kidney disease and develop acid reflux, talk to your doctor about what type of medicine you should use. You may be limited in what you can use, particularly if you're on dialysis.

[See: 5 Ways to Reduce Your Risk of Developing Kidney Disease.]

Or Does Acid Reflux Cause Kidney Disease?

There's another side of the acid reflux-kidney disease connection. It's the question of whether proton pump inhibitors for treating acid reflux can lead to kidney disease. For instance, a 2019 study in Scientific Reports reviewed 10 million FDA Adverse Event Reporting System records and found a kidney-related adverse reaction in 5.6% of those using PPIs. That compared to only 0.7% among those who were using an H2 blocker. This means that those using PPIs were 28.4 times more likely to report kidney disease than those not using PPIs.

There are several other studies that have found a connection between PPI use and interstitial nephritis, a type of rare kidney disease that can be caused by using an excessive amount of PPIs. In fact, 60% to 70% of interstitial nephritis is said to be linked to drug-induced causes, according to a study published in Nature Review Nephrology. However, once a person with this condition stops using PPIs, kidney function improves.

Doctors who treat kidney patients also notice anecdotally that PPIs can cause kidney problems, Malhotra says. He has observed patients who are using a PPI and come to his office due to new kidney problems. Once the patients stop using a PPI, their kidney function improves. However, Malhotra also acknowledges that there are many people who use PPIs and never have any kidney problems.

"More episodes of chronic kidney disease were noted in populations of patients taking PPIs than those that did not (take them), but a direct causal relationship of PPIs and chronic kidney disease is lacking," says Dr. Robert C. Greenwell, chief of nephrology at Mercy Medical Center in Baltimore.

Ultimately, Malhotra tends to steer his kidney patients clear of PPIs when possible because of other side effects, including a risk for low magnesium. If someone really needs a PPI, he'll OK it for a short period, like a couple of weeks. Otherwise, using an H2 blocker appears to have fewer side effects than using a PPI, he says. He will also recommend nonmedication adjustments to help treat acid reflux. (See below.)

Rubinov agrees, saying, "H2 blockers are a great alternative for patients who are unable to tolerate or take PPIs due to their side effects."

Greenwell also advises patients that if they can control acid reflux with H2 blockers, they should stick with that type of medicine instead of using PPIs. However, for some patients, PPIs are more effective. Greenwell also focuses on well-established links to kidney disease, such as obesity, smoking, high blood pressure and having diabetes.

[SEE: Who Can Help Me With Kidney Problems?]

Treating and Preventing Acid Reflux

Whether or not you have kidney disease, it's good to stay aware of your acid reflux symptoms and how often they happen.

You should see a doctor for acid reflux if you have the following:

-- You experience acid reflux more than once or twice a week.

-- The burning sensation associated with acid reflux is getting worse.

-- Your symptoms aren't going away, even after you've tried some lifestyle modifications.

It's important to see a doctor for worsening symptoms of acid reflux to rule out a more serious health problem. For example, Barrett's esophagus is a complication of long-term GERD. It's associated with a small risk of esophageal cancer.

There are also a few steps you can take to help prevent acid reflux that don't involve medications:

-- Experiment to find out what foods trigger your acid reflux. These may include chocolate, coffee, peppermint or spicy foods. Avoid those foods when possible.

-- Elevate your head when you sleep at night by 6 to 8 inches. You can do this by using additional pillows or by placing a foam wedge piece under your mattress, Rubinov suggests.

-- Maintain a healthy weight.

-- Quit smoking.

-- If you have diabetes, keep it under control.

-- Don't eat two to three hours before bed.

-- Wear loose-fitting clothing. Tighter clothing can make the stomach feel tighter, triggering more severe reflux symptoms.

Vanessa Caceres began writing for U.S. News in 2017, originally specializing in diabetes. She's a nationally published health, travel and food writer with an undergraduate degree in journalism and psychology from Hampshire College in Amherst, Massachusetts, and a graduate degree in linguistics/bilingual education from Georgetown University in Washington, D.C. In addition to U.S. News, Vanessa's health writing has been published with Everyday Health, Self, Newsday HealthLink, EyeWorld, The Rheumatologist and various other publications. She is a member of Business Networking International (BNI). Connect with her on Twitter at @FloridaCulture.