Complementary and Alternative Medicine for Dialysis Patients: Potential Risks and Benefits

Complementary and alternative medicine (CAM) are health therapies and products that are not considered conventional medicine. These therapies have a broad user base in the United States and are reported to help some individuals, but are mostly untested for safety, effectiveness, and purity. Approximately 55 percent of Americans use CAM in conjunction with conventional medicine. A qualitative study that explored CAM use in dialysis patients (101 patients with an 80.5 percent response rate to the study’s questionnaire) found that 18.8 percent of these patients used CAM and 63 percent were interested in further exploration. Approximately 37 percent did not report this use to their physicians. This can pose a large health risk, particularly if herbal supplements are involved. It is important for physicians to be familiar with CAM therapies, to discuss with their patients potential CAM risks and interactions and to be aware of any alternative therapies their patients are receiving or exploring.

CAM modalities range widely and can include the following:

• Alternative medical systems, such as Ayurveda, acupuncture, naturopathy, homeopathy, Siddha and Unani
• Biologically-based therapies, such as herbal therapy
• Mind-body interventions, such as yoga, meditation, relaxation techniques, biofeedback, spiritual healing and hypnosis
• Manipulative and body-based methods, such as massage therapy, chiropractic or osteopathy
• Energy therapies, such as energy healing and Reiki

While there may be benefits to CAM therapies, the research is not conclusive and is not part of conventional practice. Studies on CAM for dialysis patients are limited in number and scope. Patients who are unfamiliar with interpreting research may conclude that because a result was published in a study it must be true, or because a therapy is available to the general public it must be safe and effective. It is important for dialysis patients to discuss any such therapies with their nephrologist and their interdisciplinary care team.

The following lists examples of studies that have been published on CAM.

Herbal medicine: In an observational study (n=100), Ayurvedic herbal medicines reduced symptoms (including nausea, vomiting, loss of appetite, edema and leg cramps) and improved kidney function. A randomized controlled trial indicated the potential of hypha Cordyceps and ginkgo leaf to decrease micro-inflammation in hemodialysis patients.

While some herbs have shown therapeutic promise, many have not undergone the rigor of randomized controlled trials and Food and Drug Administration (FDA) review. Without FDA scrutiny, any potentially harmful chemical can be called any name and marketed as a food or dietary supplement. The ingredients and doses can also vary substantially across different brands.

In addition to lacking regulation and consistency, herbs can cause interactions with medications and adverse effects, such as the following:

• Diuretic herbs, which some dialysis patients believe will stimulate kidney function, can increase the glomerular filtration rate and urine output but may ultimately negatively affect serum electrolytes and lead to cardiovascular issues.
• Aristolochic acid, an extract from a plant species often used in Chinese medicine, can cause acute kidney injury, such as aristolochic acid nephropathy or Balkan endemic nephropathy.
• John’s wort can interfere with the blood levels of specific renal transplant medications.

Mindfulness meditation: A meta-analysis conducted on mindfulness therapy for pain found significant benefits in lowering depression and raising physical and mental quality of life. Modest but statistically significant reductions in blood pressure were reported in a 2013 study of borderline or pre-hypertensive patients undergoing mindfulness therapy. A randomized controlled trial reported that mindfulness meditation was well-tolerated and had subjective benefits for dialysis patients, though no significant changes were noted in anxiety and depression symptoms.

Biofeedback: Biofeedback, a process in which a typically autonomic body function is electronically monitored to train a person to voluntarily control the function, has been shown to reduce blood pressure and have a relaxing effect. With regard to kidney patients, one randomized controlled trial reported that respiratory biofeedback worked as a respiratory muscle therapy in patients with chronic renal failure. Further, a review of eight trials found biofeedback applied during dialysis reduced the frequency of interdialytic hypotension.

Acupuncture: A review of 24 studies on acupuncture for patients with kidney disease reported that, while acupressure may improve a depressive mood, fatigue and sleep in hemodialysis patients, quality evidence for the effectiveness of acupuncture for kidney disease symptoms was low. The authors noted that the potential of acupuncture for pain control in dialysis patients warrants additional research.

Yoga: A 2017 study of a six-month yoga program reported reductions in blood pressure, improved renal function and improved quality of life in patients with kidney disease. A second study demonstrated that a yoga intervention in patients with mild hypertension can reduce blood pressure over 24-hour monitoring periods.

Complementary and alternative therapies, particularly those that include herbs or nutritional supplements, remain largely untested for safety, efficacy and purity. There is real risk that some of these could cause harm to dialysis patients. The relaxation response derived from many of these therapies may help alleviate certain symptoms in kidney patients in a non-invasive way. However, with consideration to inconclusive research and potential adverse effects, it is important for physicians and the interdisciplinary care team to be fully aware of any CAM therapies, particularly herbs or purported nutritional supplements that patients are taking, to help patients make educated decisions in managing their health and kidney disease.