CKD Patients' High Rate Of Acid Reflux May Be Leading To Serious Complications

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Gastroesophageal Reflux Disease (GERD), also called acid reflux, is a common upper gastrointestinal disorder in people with Chronic Kidney Disease (CKD). Untreated GERD can cause serious complications over time, including severe irritation of the esophagus from refluxed stomach acid that damages the lining and causes bleeding or ulcers (esophagitis). Adults who have chronic esophagitis over many years are more likely to develop precancerous changes in the esophagus. In rare cases individuals with GERD have developed Barrett’s esophagus, a condition in which the tissue lining the esophagus is replaced by tissue similar to the lining of the intestine. A small number of people with Barrett’s esophagus have even developed a very deadly type of cancer of the esophagus. More commonly, acid reflux can lead to swallowing difficulties, vomiting and respiratory problems, such as trouble breathing.

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GERD most often results in individuals with CKD when the muscle that acts as a valve between the esophagus and stomach (lower esophageal sphincter) becomes weak or relaxes when it should not, causing stomach contents to rise up into the esophagus. Factors that can contribute to GERD in CKD patients include obesity, smoking, or inhaling secondhand smoke, and more frequently certain medications, such as asthma medications, pain killers, sedatives, antidepressants, many antihistamines and high blood pressure medications (calcium channel blockers).

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High blood pressure is a leading cause of CKD and even those that contract CKD from other means such as Diabetes or Kidney Failure, struggle with elevated blood pressure after diagnoses. Antihypertensive medications have multiple mechanisms of action to help lower blood pressure. One class of such drugs is called calcium-channel blockers and they are quite effective at lowering blood pressure in people with CKD. But calcium-channel blockers relax a type of muscle cell in the body called smooth muscle (hormones and other local factors control these muscle cells). Smooth muscle is a muscle type that is not within your conscious control, unlike the muscles in your arms or legs. Your high blood pressure falls as smooth muscles that line your blood vessels are relaxed. However, smooth muscle also lines your gut, including the esophagus, the lower esophageal sphincter, and the colon (large intestine). Side effects of calcium channel blockers can lead to GERD.

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Some people can reduce GERD symptoms by losing weight (if overweight) and wearing loose-fitting clothing around the stomach area because tight clothing can constrict the area and increase reflux. Dietary changes that can help reduce symptoms which include decreasing fat intake and eating small, frequent meals instead of three large ones. Those with CKD who are overweight should talk with their Dietitian regarding dietary changes that can alleviate GERD BEFORE enacting any changes themselves. Additionally, remaining upright for 3 hours after meals can help combat symptoms of acid reflux and raising the head of your bed 6 to 8 inches by securing wood blocks under the bedposts can also help. Just using extra pillows may not be effective.

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Proton Pump Inhibitors (PPIs) are very effective in relieving symptoms and healing the esophageal lining in most CKD patients with GERD so Nephrologists often prescribe PPIs for long-term management of acid reflux. However, studies show people who take PPIs long-term or in high doses are more likely to have hip, wrist, and spinal fractures. Hence, you should remain vigilante and aware of the medication's effects on your body.

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All medications have desired actions and possible side effects. Sometimes when a medicine is prescribed for one problem, it can end up leading to another problem. Every individual’s body can react differently to various medications, and it is not always possible to predict drug effects and side effects. You and your  Nephrologist should monitor your symptoms to prevent or treat long-term complications associated with GERD.

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"National Digestive Diseases Information Clearinghouse (NDDIC)." Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults. A Service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH)

"Can Medicines Cause Acid Reflux?" Acid

"What Medications Can Make Acid Reflux Worse?" Acid

"Prevalence of Gastroesophageal Reflux Disease in Peritoneal Dialysis and Hemodialysis Patients." A Service of the U.S. National Institutes of Health