Monday, 3 December 2012

 Use of Herbal Supplements in 

Chronic Kidney Disease

    As a chronic kidney disease (CKD) patient, you may have considered the use of herbal products to assist you with various health concerns. This fact sheet will give you some information to enable you to make decisions regarding your use of herbs.

Use of herbal supplements may be unsafe for CKD patients, since your body is not able to clear waste products like a healthy person. There are some facts about herbs that every CKD patient should know:
  • Very few herbs have been studied in CKD patients. What may be safe for healthy persons may not be safe for someone with CKD, and in fact, could be dangerous. Therefore, you need to be very cautious about your use of these products.
  • The government does not regulate herbal supplements, so the exact content of these products is unknown.
  • Without regulation, there are no requirements for testing, so the purity, safety and effectiveness of the products are unknown.
  • Herbal preparations are subject to contamination (may contain toxic heavy metals such as lead or mercury).
  • Products may contain minerals harmful to CKD patients, for example: potassium.
Some herbs that may serve as diuretics may also cause “kidney irritation” or damage. These include bucha leaves and juniper berries. Uva Ursi and parsley capsules may have negative side effects as well.

Many herbs can interact with prescription drugs. A few examples are St. Johns Wort, echinacea, ginkgo, garlic, ginseng, ginger, and blue cohosh. Transplant patients are especially at risk, as any interaction between herbs and medications could potentially put them at risk for rejection or losing the kidney. It is important to ask your doctor and/or pharmacist about any herbs or medicines you want to take to avoid potential problems.

Herbs that may be toxic to the kidneys
Artemisia absinthium (wormwood plant) Periwinkle
Autumn crocus Sassafras
Chuifong tuokuwan (Black Pearl) Tung shueh
Horse chestnut Vandelia cordifolia


Herbs that may be harmful in chronic kidney disease
Alfalfa Buckthorn Ginger Nettle Vervain
Aloe Capsicum Ginseng Noni juice
Bayberry Cascara Horsetail Panax
Blue Cohosh Coltsfoot Licorice Rhubarb
Broom Dandelion Mate Senna


Herbs known to be unsafe for all people
Chapparal Pennyroyal
Comfrey Pokeroot
Ephedra (Ma Huang) Sassafras
Lobelia Senna
Mandrake Yohimbe

These lists are not necessarily complete. More information regarding the use of herbs will become available over time. You are encouraged to proceed with caution with all herbal preparations and use them only under the direction of your medical team.
With all of these cautions, perhaps you are wondering if use of any herbs is a good idea. The use of common herbs, in normal amounts, when cooking is just fine and typically recommended to enhance the flavor of foods on a low-sodium diet.
So, before you take any herbal supplement, we recommend:
  • Checking with your doctor, dietitian, pharmacist and/or product manufacturer regarding safety, dosage, duration of use, interactions with prescription drugs, etc.
  • Use only standardized herbal extracts made by reputable companies.
  • Never take more than the recommended dosage, or longer than recommended.
  • Do not use herbal remedies for serious illness.
  • Do not use herbs if considering pregnancy.
Remember … natural does not mean safe, especially for CKD patients. Be smart and ask questions before using any herbal products.
The following references can provide additional information regarding the use of herbal supplements:
PDR for Herbal Medicines . Gruenwald J, Bendler T, Jaenicke C, eds. Montvale NJ: Medical Economics Company, Inc., 2000
The Honest Herbal . Tyler V. Pharmaceutical Products Press, New York, 1999
More than 20 million Americans—one in nine adults—have chronic kidney disease, and most don't even know it. More than 20 million others are at increased risk. The National Kidney Foundation, a major voluntary health organization, seeks to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability of all organs for transplantation. Through its 50 affiliates nationwide, the foundation conducts programs in research, professional education, patient and community services, public education and organ donation. The work of the National Kidney Foundation is funded by public donations.
The National Kidney Foundation would like to thank the
Council on Renal Nutrition for the development of this fact sheet.

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About Chronic Kidney Disease

Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function over time. To read more about kidney function, see How Your Kidneys Work. CKD is also known as chronic renal disease.

What is chronic kidney disease (CKD)?

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

The Facts About Chronic Kidney Disease (CKD)

  • 26 million American adults have CKD and millions of others are at increased risk.
  • Early detection can help prevent the progression of kidney disease to kidney failure.
  • Heart disease is the major cause of death for all people with CKD.
  • Glomerular filtration rate (GFR) is the best estimate of kidney function.
  • Hypertension causes CKD and CKD causes hypertension.
  • Persistent proteinuria (protein in the urine) means CKD is present.
  • High risk groups include those with diabetes, hypertension and family history of kidney disease.
  • African Americans, Hispanics, Pacific Islanders, Native Americans and Seniors are at increased risk.
  • Three simple tests can detect CKD: blood pressure, urine albumin and serum creatinine.

What causes CKD?

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.
Other conditions that affect the kidneys are:
  • Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney's filtering units. These disorders are the third most common type of kidney disease.
  • Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue.
  • Malformations that occur as a baby develops in its mother's womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.
  • Lupus and other diseases that affect the body's immune system.
  • Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.
  • Repeated urinary infections.

What are the symptoms of CKD?

Most people may not have any severe symptoms until their kidney disease is advanced. However, you may notice that you:
  • feel more tired and have less energy
  • have trouble concentrating
  • have a poor appetite
  • have trouble sleeping
  • have muscle cramping at night
  • have swollen feet and ankles
  • have puffiness around your eyes, especially in the morning
  • have dry, itchy skin
  • need to urinate more often, especially at night.
Anyone can get chronic kidney disease at any age. However, some people are more likely than others to develop kidney disease. You may have an increased risk for kidney disease if you:
  • have diabetes
  • have high blood pressure
  • have a family history of chronic kidney disease
  • are older
  • belong to a population group that has a high rate of diabetes or high blood pressure, such as African Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians.

Learn more About Glomerular Filtration Rate (GFR)

GFR—glomerular filtration rate is the best test to measure your level of kidney function and determine your stage of kidney disease. Your doctor can calculate it from the results of your blood creatinine test, your age, race, gender and other factors.
The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.

What happens if my test results show I may have chronic kidney disease?

Your doctor will want to pinpoint your diagnosis and check your kidney function to help plan your treatment. The doctor may do the following:
  • Calculate your Glomerular Filtration Rate (GFR), which is the best way to tell how much kidney function you have. You do not need to have another test to know your GFR. Your doctor can calculate it from your blood creatinine, your age, race, gender and other factors. Your GFR tells your doctor your stage of kidney disease and helps the doctor plan your treatment.
  • Perform an ultrasound or CT scan to get a picture of your kidneys and urinary tract. This tells your doctor whether your kidneys are too large or too small, whether you have a problem like a kidney stone or tumor and whether there are any problems in the structure of your kidneys and urinary tract.
  • Perform a kidney biopsy, which is done in some cases to check for a specific type of kidney disease, see how much kidney damage has occurred and help plan treatment. To do a biopsy, the doctor removes small pieces of kidney tissue and looks at them under a microscope.
Your doctor may also ask you to see a kidney specialist who will consult on your case and help manage your care.
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