What Antacids Are Safe for Kidneys?

Have heartburn? You’re far from alone. According to the NIH, nearly 20% of Americans experience heartburn at least once a month. At the same time, roughly 15% of the U.S. population has kidney disease.

If you have heartburn and are worried about your kidney health, or if you have chronic kidney disease and are experiencing heartburn, you’re probably wondering how you can safely control your symptoms. 

As your kidneys are responsible for filtering medications, it’s important to understand how those medications impact your kidney health. Otherwise, one solution becomes the cause of another health problem. 
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In this article, we’ll dig into heartburn medications, how they work, and which ones are safe for your kidneys.

Understanding the Different Treatments for Heartburn, Acid Reflux, and GERD

‘Antacid’ is frequently used as a placeholder for any heartburn relief medication. But among the wide variety of heartburn medications, there are several different active ingredients.

Likewise, heartburn, acid reflux, and gastrointestinal reflux disease (GERD) are often used interchangeably, but they aren’t the same thing. GERD is a diagnosable condition; acid reflux causes GERD, and heartburn is a symptom of GERD and acid reflux. You don’t need to have GERD to experience heartburn.

Each heartburn medication has a different impact on your kidney health, so it’s important to understand their distinct properties. Let’s take a closer look at the three most common types of heartburn relief medications.

1. Antacids

Antacids are one of the most common treatments for unexpected heartburn. You would take it after eating. They come in two forms: a water-soluble pellet like Alka-Seltzer, or a chewable tablet like Tums.

Calcium Carbonate Antacids

These antacids use calcium carbonate to reduce the amount of acid in your stomach. The calcium carbonate chemically reacts with the hydrochloric acid that your stomach secretes. That chemical reaction neutralizes the acid, creating water, carbon dioxide, and calcium chloride. Calcium chloride isn’t healthy, but the miniscule amount produced by an antacid will rarely have an observable impact on your health unless taken regularly. ​

Aluminum Hydroxide and Magnesium Hydroxide Antacids

Like calcium carbonate antacids, aluminum hydroxide and magnesium hydroxide react with hydrochloric acid in the stomach, forming aluminum chloride and magnesium chloride, respectively. Aluminum hydroxide and magnesium hydroxide antacids are used with caution in patients with chronic kidney disease (CKD). ​

2. H2 Blockers

Imagine if your stomach were a house, and to start producing acid it needed to receive a letter telling it to do so. You could prevent the production of acid by boarding up the mail slot. That’s essentially what H2 blockers do.
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Certain cells in your stomach’s lining control stomach acid production. When you eat fatty foods, the H2 histamine receptor in those cells receives the signal to increase acid production, leading to acid reflux and heartburn. H2 blockers prevent your stomach cells from receiving that signal in the first place.

Some H2 blockers also include calcium carbonate to reduce the amount of acid in your stomach, in addition to temporarily limiting the production of acid.

3. Proton Pump Inhibitors (PPIs)

PPIs are effective for a longer time period than other heartburn relievers. Most heartburn medications provide relief for 2-12 hours, while PPIs last roughly 24 hours. They’re usually taken by people with chronic heartburn and may be prescribed to patients who’ve had bleeding stomach ulcers. 
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PPIs work by targeting an enzyme that pumps hydrogen ions into the stomach, which ultimately leads to the production of gastric acid. PPIs bind to that enzyme, preventing it from properly signaling the need to produce acid.

Which Antacids Are Safe For Kidneys?

When it comes to your kidney health, most antacids are safe, but you should speak to your physician about using them, especially if you’re at risk for or have CKD.

An allergic reaction to a PPI could lead to interstitial nephritis, an inflammation of the filters in your kidneys. This can reduce your kidneys’ ability to function, ultimately leading to numerous other health risks, such as high blood pressure and CKD. An analysis of numerous studies found that PPI use was associated with a risk for CKD, but also notes that until more conclusive studies can confirm the risk, PPIs may still be used cautiously to treat GERD.

Additionally, some antacids could cause an imbalance in your body’s electrolyte balance if you have CKD. At the same time, calcium carbonate antacids may be used to control phosphorus levels in patients with CKD, as their kidneys can’t remove phosphorus like a healthy kidney would. Therefore, it’s critical to talk to your doctor before taking heartburn relief medication.

​In general, antacids and H2 blockers should only be used to manage short-term symptoms, and PPIs should be used at the lowest dose for the shortest period of time, according to guidance from the American Gastroenterological Association.

Alternatives to Antacids and Heartburn Medications

Depending on your circumstances, your physician may recommend alternatives to heartburn medications. Common strategies to naturally ease the discomfort caused by heartburn and acid reflux include:

• Increasing the amount of exercise you get each week: If you’re overweight, there may be additional pressure on your lower esophageal sphincter (LES). The LES is a valve that separates your stomach from your esophagus. The additional pressure on it can contribute to the way stomach acid flows back into the esophagus. Exercising more frequently and losing weight can reduce the pressure on your LES and reduce how frequently heartburn occurs.
  
• Removing fatty foods from your diet: As you know by now, fatty foods stimulate stomach acid production. By reducing the amount of fatty foods you eat, you may be able to decrease how much acid your stomach is producing. Additionally, fatty foods take longer to digest. This means that your stomach will be full and vulnerable to acid reflux and heartburn for a longer period.
  
• Changing your sleeping position: If you have GERD or frequent heartburn, your doctor might recommend you prop up your mattress with a wedge-shaped block. Doing so may help reduce heartburn symptoms in two ways. First, it can help your esophagus drain naturally with the help of gravity. Secondly, like losing weight, it can reduce pressure on your LES while sleeping.
  

In most cases, your heartburn symptoms can be managed and even eliminated. However, it’s important to speak with your care team to create a plan that won’t put your kidney health at risk.

Milwaukee Nephrologists: Southeastern Wisconsin’s Kidney Experts

With a team of board-certified specialists and a wide variety of sub specializations, Milwaukee Nephrologists is your go-to resource for kidney-health concerns. To learn more about protecting and caring for your kidneys, check out our other educational articles, or get in touch with our staff of nephrologists, transplant specialists, and dietitians to schedule an appointment.