CAM Use in More Than One-Third of Patients With CKD

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 CAMResults 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 UseBased 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.


Traditional medicine provides health care to many around the globe—the WHO is trying to make it safer

For approximately 80% of the world’s population, the first stop after catching a cold or breaking a bone isn’t the hospital—maybe because there isn’t one nearby, or they can’t afford it. Instead, the first step is consulting traditional medicine, which cultures around the world have been using for thousands of years.

Traditional medicine encompasses the healing knowledge, skills and practices used by a variety of cultures and groups.

Examples of traditional medicine include herbal medicine; acupuncture; Tui Na—which is a type of massage originating in China; Ayurveda—which is an ancient system of promoting health through diet, exercise and lifestyle from India; and Unani—which is another ancient system of health from South Asia, balancing key aspects of the mind, body and spirit.

In recognizing that traditional medicine and other alternative forms of healing are critical sources of health care for many people worldwide, the World Health Organization and the government of India co-hosted their first-ever Traditional Medicine Summit. The summit took place in August 2023 in Gandhinagar, Gujarat, India.

The summit brought together health care policymakers, traditional medicine workers and users, international organizations, academics and private sector stakeholders from 88 WHO member states. Leaders at the summit aimed to share best practices and scientific evidence and data around traditional medicine.

As researchers interested in how to provide patients both in the U.S. and around the globe with the best possible medical care, we were interested in the summit’s findings. Understanding traditional medicine can help health care professionals create sustainable, personalized and culturally respectful practices.

Critical health care for manyIn many countries, traditional medicine costs less and is more accessible than conventional health care. And many conventional medicines come from the same source as compounds used in traditional medicine—up to 50% of drugs have a natural product root, like aspirin.

Many factors may influence whether someone chooses traditional medicine, such as age and gender, religion, education and income level, and distance to travel for treatment. Cultural factors may also influence people’s use of traditional medicine.

In China, for example, as more people have embraced Western culture, fewer have chosen traditional medicine. In contrast, many African migrants to Australia continue to use traditional medicine to express their cultural identity and maintain a cohesive ethnic community. A patient’s preference for traditional medicine often has significant personal, environmental and cultural relevance.

A framework for traditional medicineCountries have been pushing the WHO to study and track data on traditional medicine for years. In the past, WHO has developed a “traditional medicine strategy” to help member states research, integrate and regulate traditional medicine in their national health systems. August 2023 marked the WHO’s first global summit on traditional medicine.

The WHO also created international terminology standards for practicing various forms of traditional medicine.

The practice of traditional medicine varies greatly between countries, depending on how accessible it is and how culturally important it is in each country. To make traditional medicine safer and more accessible on a broader scale, it’s important for policymakers and public health experts to develop standards and share best practices. The WHO summit was one step toward that goal.

The WHO also aims to collect data that could inform these standards and best practices. It is conducting the Global Survey on Traditional Medicine in 2023. As of August, approximately 55 member states out of the total 194 have completed and submitted their data.

Acupuncture—a case study in safety and efficacySome traditional medicine practices such as acupuncture have shown consistent and credible benefits, and have even started to make it into mainstream medicine in the U.S. But leaders at the summit emphasized a need for more research on the efficacy and safety of traditional medicine.

Although traditional medicine can have a range of benefits, some treatments come with health risks.

For example, acupuncture is a traditional healing practice that entails inserting needles at specific points on the body to relieve pain. But acupuncture can cause infections and injuries if the practitioner doesn’t use sterile needles or if needles are inserted incorrectly.

Still, acupuncture is the most commonly used traditional medicine practice across countries, with 113 WHO member states acknowledging their citizens practiced acupuncture in 2019.

Interestingly, battlefield acupuncture has successfully treated many U.S. military members, for example, for pain reduction. It is simple to use, transportable and has no risk of addiction.

There’s also some evidence supporting the use of traditional medicine, including acupuncture, meditation and yoga to treat post-traumatic stress disorder.

However, acupuncture practitioners aren’t trained in a uniform way across countries. To provide guidelines for best practice, the WHO developed standardized benchmarks for practicing acupuncture in 2021. The WHO aims to develop similar standards for other forms of traditional medicine as well.

Interest in traditional medicine is growing among those who have mainly used conventional medicine in the past. More research and collaborative efforts to develop safety standards can make traditional medicine accessible to all who seek it.

This article is republished from The Conversation under a Creative Commons license. Read the original article.The Conversation

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