Many patients with CKD, including transplant recipients, do not disclose use of complementary and alternative medicine to their doctors.
The prevalence of CKD is increasing globally, partly due to the rising incidence of other risk factors, such as obesity, hypertension, and diabetes. Global epidemiology studies have shown that complementary and alternative medicine (CAM) use among patients with CKD varies widely compared with the general population. CAM comprises diverse medical and healthcare systems, practices, and products that are generally not considered a part of conventional medicine.
Due to the financial and psychosocial burden of CKD, many patients consider using CAM to manage the disease symptoms. “Previous reports suggest that CAM use among patients living with CKD is widespread,” says Maryam Farooqui, PhD, BPharm, MPharm. However, little is known about the safety and efficacy of CAM, especially herbal remedies, in patients with CKD and those who have received a kidney transplant. Potential risks include adverse drug events, nephrotoxicity, and significant drug–nutrient interaction with immunosuppressive and other medications.
For a study published in the Journal of Pharmaceutical Policy and Practice, Dr. Farooqui and colleagues evaluated the prevalence, types, and nondisclosure of CAM use among patients with CKD, including patients who received a kidney transplant in Saudi Arabia (N=170). In addition, they investigated the source of information about CAM use, monthly expenditures on CAM, and whether participants disclosed their CAM use to their healthcare providers. Of the study cohort, 121 patients had stage 3 or 4 CKD, two had stage 5 CKD and received dialysis, and 47 had received a kidney transplant.
Three Out of Four Patients With Stage 5 CKD Use CAM
Results from the study showed that more than one-third (35.3%) of patients with CKD reported using at least one type of CAM therapy since their CKD diagnosis. A subgroup analysis found that CAM use was highest among patients with stage 5 CKD on hemodialysis (76.6%), followed by patients with stage 3 or 4 CKD (21.6%), and transplant recipients (1.8%). Among all sociodemographic variables, women with CKD had higher use of CAM than men with CKD.
The most commonly used CAM modalities were herbal therapies (28.2%), followed by a range of different spiritual therapies. Other less popular CAM practices included taking honey and multivitamins or supplements. “Most CAM users reported spending a minimal amount of money on CAM,” says Dr. Farooqui. Results also showed that patients in the early stages of CKD showed more interest in using CAM than those with more advanced disease. About 16% of patients relied on advice from family members or friends as a source of information about CAM. The second most reliable source of information was social media (12%), followed by their own decision (10%).
The study also revealed that 45% of patients with CKD who used CAM disclosed it to their healthcare professionals (Table). Most physicians were supportive of CAM use when their patients disclosed that they were using CAM. “Most patients who did not disclose their CAM use to physicians reported believing it was not important to disclose this information,” Dr. Farooqui says. Of note, investigators found that 46.6% of CAM users discontinued using it after observing no benefits.
Physicians Should Be Vigilant for CAM Use
Based on the study’s findings, improved communication between healthcare providers and patients is crucial to protect patients with CKD from potential adverse effects of CAM. “Healthcare providers need to be more vigilant regarding the use of CAM among patients with CKD at every stage of the disease,” says Dr. Farooqui. “Providersshould initiate discussions and encourage their patients to talk about CAM use to avoid potential harm to the kidneys.” In addition, pharmacists can be consulted to help educate patients and other healthcare professionals about the safe and effective use of CAM while highlighting its potential toxic effects.