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 people who don't have kidney disease. 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 individuals 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 contents of these products are unknown.
• Without regulation, there are no requirements for testing, so the purity, safety and effectiveness of these products are also unknown.
• Herbal preparations are subject to contamination, and may contain toxic, heavy metals such as lead or mercury.
• Products may contain minerals harmful to CKD patients, like 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. John's 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 in this regard to avoid potential problems.

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 doctor, pharmacist and the other members 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 fine and typically recommended to enhance the flavor of foods on a low-sodium diet.

So, before you take any herbal supplement, we recommend:

1. Checking with your doctor, dietitian, pharmacist and/or product manufacturer regarding the safety, dosage, duration of use, interactions with prescription drugs, etc. for all herbal products.
2. Use only standardized herbal extracts made by reputable companies.
3. Never take more than the recommended dosage, or use longer than recommended.
4. Do not use herbal remedies for serious illness.
5. Do not use herbs if you are pregnant or trying to become pregnant.

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:

American Botanical Council

National Center for Complementary and Alternative Medicine

National Library of Medicine, Medline Plus

Quackwatch

United States Pharmacopoeia

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.