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Lu PH, Yao XF, Lin YS, Tzeng IS, Lu PH, Kuo KL. Omega-3 fatty acids for uremic pruritus: A meta-analysis of randomized controlled trials. Tzu Chi Med J 2022; 34:394-401. [PMID: 36578647 PMCID: PMC9791849 DOI: 10.4103/tcmj.tcmj_221_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 12/31/2022] Open
Abstract
Uremic pruritus (UP) is common in the late stages of chronic kidney disease. Currently, there is a lack of effective treatment for UP. Limited evidence exists on the therapeutic effect of omega-3 fatty acid (O3FA). The aim of this study was to evaluate the efficacy of O3FA supplements in UP patients. We evaluated the efficacy of O3FA supplements in patients with UP through a systematic review and a meta-analysis of randomized control trials retrieved from PubMed, Embase, Cochrane Library, CINAHL, and ClinicalTrials.gov databases. The included studies were summarized and assessed for the risk of bias, and pruritus assessment results were analyzed. To compared with a controlled group, five articles including 164 participants published between 2012 and 2019 using different pruritus scales reported that patients taking O3FA supplement exhibited no significant decrease in the pruritus score (standardized mean difference [SMD] =1.34, 95% confidence interval [CI] = -2.70-0.01, P = 0.05), but three articles using same pruritus scale significant decrease Duo pruritus score (SMD = -0.85, 95% CI = -1.39 to -0.30, P < 0.05). O3FA supplement could be an appealing complementary therapy for UP patients. More rigorously designed studies are needed before recommending the O3FA supplement.
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Affiliation(s)
- Ping-Hsun Lu
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan,School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Xiao-Feng Yao
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yang-Sheng Lin
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan,Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Po-Hsuan Lu
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan,Department of Medicine, MacKay Medical College, New Taipei, Taiwan,Address for correspondence: Dr. Po-Hsuan Lu, Department of Medicine, Mackay Medical College, 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei, Taiwan. E-mail:
Dr. Ko-Lin Kuo, Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289, Jianguo Road, Xindian District, New Taipei, Taiwan. E-mail:
| | - Ko-Lin Kuo
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan,School of Medicine, Tzu Chi University, Hualien, Taiwan,Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan,Address for correspondence: Dr. Po-Hsuan Lu, Department of Medicine, Mackay Medical College, 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei, Taiwan. E-mail:
Dr. Ko-Lin Kuo, Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289, Jianguo Road, Xindian District, New Taipei, Taiwan. E-mail:
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Wu CW, Chen HY, Yang CW, Chen YC. Deciphering the Efficacy and Mechanisms of Chinese Herbal Medicine for Diabetic Kidney Disease by Integrating Web-Based Biochemical Databases and Real-World Clinical Data: Retrospective Cohort Study. JMIR Med Inform 2021; 9:e27614. [PMID: 33973855 PMCID: PMC8150407 DOI: 10.2196/27614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/01/2021] [Accepted: 04/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background Diabetic kidney disease (DKD) is one of the most crucial causes of chronic kidney disease (CKD). However, the efficacy and biomedical mechanisms of Chinese herbal medicine (CHM) for DKD in clinical settings remain unclear. Objective This study aimed to analyze the outcomes of DKD patients with CHM-only management and the possible molecular pathways of CHM by integrating web-based biomedical databases and real-world clinical data. Methods A total of 152,357 patients with incident DKD from 2004 to 2012 were identified from the National Health Insurance Research Database (NHIRD) in Taiwan. The risk of mortality was estimated with the Kaplan-Meier method and Cox regression considering demographic covariates. The inverse probability of treatment weighting was used for confounding bias between CHM users and nonusers. Furthermore, to decipher the CHM used for DKD, we analyzed all CHM prescriptions using the Chinese Herbal Medicine Network (CMN), which combined association rule mining and social network analysis for all CHM prescriptions. Further, web-based biomedical databases, including STITCH, STRING, BindingDB, TCMSP, TCM@Taiwan, and DisGeNET, were integrated with the CMN and commonly used Western medicine (WM) to explore the differences in possible target proteins and molecular pathways between CHM and WM. An application programming interface was used to assess these online databases to obtain the latest biomedical information. Results About 13.7% (20,947/131,410) of patients were classified as CHM users among eligible DKD patients. The median follow-up duration of all patients was 2.49 years. The cumulative mortality rate in the CHM cohort was significantly lower than that in the WM cohort (28% vs 48%, P<.001). The risk of mortality was 0.41 in the CHM cohort with covariate adjustment (99% CI 0.38-0.43; P<.001). A total of 173,525 CHM prescriptions were used to construct the CMN with 11 CHM clusters. CHM covered more DKD-related proteins and pathways than WM; nevertheless, WM aimed at managing DKD more specifically. From the overrepresentation tests carried out by the online website Reactome, the molecular pathways covered by the CHM clusters in the CMN and WM seemed distinctive but complementary. Complementary effects were also found among DKD patients with concurrent WM and CHM use. The risk of mortality for CHM users under renin-angiotensin-aldosterone system (RAAS) inhibition therapy was lower than that for CHM nonusers among DKD patients with hypertension (adjusted hazard ratio [aHR] 0.47, 99% CI 0.45-0.51; P<.001), chronic heart failure (aHR 0.43, 99% CI 0.37-0.51; P<.001), and ischemic heart disease (aHR 0.46, 99% CI 0.41-0.51; P<.001). Conclusions CHM users among DKD patients seemed to have a lower risk of mortality, which may benefit from potentially synergistic renoprotection effects. The framework of integrating real-world clinical databases and web-based biomedical databases could help in exploring the roles of treatments for diseases.
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Affiliation(s)
- Chien-Wei Wu
- Division of Chinese Internal and Pediatric Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsing-Yu Chen
- Division of Chinese Internal and Pediatric Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Wei Yang
- Division of Chinese Internal and Pediatric Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chun Chen
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Venugopal V, Latha PK, Shanmugam R, Krishnamoorthy M, Srinivasan K, Perumal K, Chinnadurai JS. Risk of kidney stone among workers exposed to high occupational heat stress - A case study from southern Indian steel industry. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 722:137619. [PMID: 32197155 DOI: 10.1016/j.scitotenv.2020.137619] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Predicted temperature rise is likely to increase the risks of development and progression of renal/urologic anomalies for workers engaged in physically exerting and high-heat occupations. METHODS We conducted a cross-sectional study with 340 steelworkers engaged in moderate to heavy labour with ≥3 year's heat exposures and assessed Wet Bulb Globe Temperature (WBGT) and heat-strain indicators. We captured self-reported heat-strain and kidney symptoms using validated questionnaires and subjected 91 workers to renal ultrasound upon referral of an occupational health specialist to detect and confirm any structural renal anomalies/stones. RESULTS The results show that heat exposures (Avg.WBGT = 33.2 °C ± 3.8 °C) exceeded the Threshold Limit Value (TLV) for 220 workers. 95% of the workers reported symptoms of heat strain and dehydration and significant associations between heat exposures, rise in Core Body Temperature (CBT) (p = 0.0001) and Urine Specific Gravity (USG) (p = 0.018) were observed. Of the 91 workers subjected to renal ultrasound, 33% were positive for kidney/ureteral stones (n = 25) & other structural renal anomalies (n = 5). Renal/urologic anomalies were higher in the heat-exposed workers (AOR = 2.374; 95% C.I = 0.927 to 6.077; p = 0.072) 29% of workers were from exposed group and 4% were from unexposed group. Years of exposure to heat (≥5 vs <5) were significantly associated with the risk of renal anomalies/calculi. CONCLUSION The preliminary finding concludes that high-heat stress combined with a heavy workload and chronic dehydration are high-risk factors for adverse renal health and calls for the urgent need for cooling interventions, enhanced welfare facilities, and protective labour policies to avert adverse health consequences for few million workers in the climate change scenario.
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Affiliation(s)
- Vidhya Venugopal
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, No: 1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
| | - P K Latha
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, No: 1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
| | - Rekha Shanmugam
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, No: 1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
| | - Manikandan Krishnamoorthy
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, No: 1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
| | - Krishnan Srinivasan
- Department of Physiology, Sri Ramachandra Institute of Higher Education and Research, No: 1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Kumaravel Perumal
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, No: 1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
| | - Jeremiah S Chinnadurai
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, No: 1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
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Pedreira-Robles G, Vasco-Gómez A, Martínez-Delgado Y, Herrera-Morales C, Junyent-Iglesias E. Traditional and complementary medicine in a nephrology department: practitioner knowledge and advice. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:426-430. [PMID: 32279559 DOI: 10.12968/bjon.2020.29.7.426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Knowledge of traditional and complementary medicine (TCM) and its use by patients are essential for patient safety. AIMS To examine knowledge of TCM among practitioners in a nephrology unit and their advice to patients. METHODS This was a descriptive, observational, cross-sectional study. Sociodemographic data were collected and an ad hoc closed response survey was used. FINDINGS This study included 62 practitioners, of whom: 32.26% had been trained in TCM, with no significant differences between professional groups; 41.93% used TCM and 67.74% recommended TCM to patients, with no significant difference between personal use and training received. The majority (62.90%) approved of TCM being included in clinical practice, 77.42% were in favour of it being included in formal health teaching programmes, 27.42% said patients had requested information on TCM and 50% knew it could interact with conventional treatment. CONCLUSION Although the majority of practitioners had not been trained in TCM, they were interested in including such treatments in clinical practice. They recommended TCM to patients, but neither training nor personal experience were significant factors in relation to these recommendations. Training in TCM is required to ensure advice is safe.
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Affiliation(s)
| | - Ana Vasco-Gómez
- Nurse, Nephrology Department, Parc de Salut Mar, Barcelona, Spain
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Touiti N, Houssaini TS, Iken I, Benslimane A, Achour S. Prevalence of herbal medicine use among patients with kidney disease: A cross-sectional study from Morocco. Nephrol Ther 2019; 16:43-49. [PMID: 31383617 DOI: 10.1016/j.nephro.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The objectives of this study were to determine the prevalence of herbal medicine use by patients hospitalized or consultant in the nephrology department of University Hospital center Hassan II Fez, the reasons of this use, to identify socio-demographic characteristics, and the etiology of kidney disease related to herbal medicine use, also the most used plants. METHOD Cross-sectional study on the use of herbal medicine conducted at the nephrology department of University Hospital Center Hassan II Fez, Morocco. During 6 months between August 2015 and February 2016. Patients older than 15 years (n=471) with varying degrees of kidney disease were included. The questionnaire contained questions related to socio-demographic data, the use of plants, knowledge about herbal medicine toxicity, and etiology of KD. Descriptive statistics were used to analyze socio-demographic characteristics related to herbal medicine use. RESULTS A total of 471 patients responded; the prevalence of herbal medicine use was 50.7%. Herbal medicine users were more likely to be males (OR 0.43; 95%CI 0.25-0.74); unemployed (OR 0.51; 95%CI 0.29-0.89), with unknown etiology (OR 0.43; 95%CI 0.22-0.84). Reasons of use were: belief in its efficacy (74%), easy access to medicinal herbal medicine (70%), and lower cost (48%). The most commonly used herbal medicine were Rosmarinus officinalis L.; Origanum compactum Benth; Artemisia herba-alba Asso and Mentha pulegium L. Potentially harmful herbal medicine included Aristolochia longa. CONCLUSIONS The prevalence of herbal medicine use is high among patients with kidney disease in nephrology department.
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Affiliation(s)
- Noufissa Touiti
- Research team toxicology and environmental health, center of biomedical and translational research, university hospital center Hassan II, road Sidi Harazem, Shore Park street, 30070 Fez, Morocco; Faculty of science and technology of Fez, university Sidi Mohammed Ben Abdellah, BP 2202, Imouzzer road, Fez, Morocco.
| | - Tarik Sqalli Houssaini
- Research team kidney, laboratory of molecular bases in human pathology and therapeutic tools, university hospital center Hassan II, road Sidi Harazem, Shore Park street, 30070 Fez, Morocco
| | - Imane Iken
- Research team toxicology and environmental health, center of biomedical and translational research, university hospital center Hassan II, road Sidi Harazem, Shore Park street, 30070 Fez, Morocco; Laboratory of toxicology, university hospital center Hassan II, road Sidi Harazem, Shore Park street, 30070 Fez, Morocco; Faculty of medicine and pharmacy of Fez, BP 1893, KM 2.200, road Sidi Harazem, Shore Park street, 30070 Fez, Morocco
| | - Abdelilah Benslimane
- Department of epidemiology clinical research and public health, medical school of Fez, Faculty of medicine and pharmacy of Fez, BP 1893, KM 2.200, road Sidi Harazem, Fez, Morocco
| | - Sanae Achour
- Research team toxicology and environmental health, center of biomedical and translational research, university hospital center Hassan II, road Sidi Harazem, Shore Park street, 30070 Fez, Morocco; Laboratory of toxicology, university hospital center Hassan II, road Sidi Harazem, Shore Park street, 30070 Fez, Morocco; Faculty of medicine and pharmacy of Fez, BP 1893, KM 2.200, road Sidi Harazem, Shore Park street, 30070 Fez, Morocco
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Kalista-Richards M. Invited Review: The Kidney: Medical Nutrition Therapy—Yesterday and Today. Nutr Clin Pract 2017; 26:143-50. [DOI: 10.1177/0884533611399923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Marcia Kalista-Richards
- From Cedar Crest College, Nutrition Department, Allentown, Pennsylvania, and Fresenius Medical Care of North America, Whitehall, Pennsylvania,
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Zyoud SH, Al-Jabi SW, Sweileh WM, Tabeeb GH, Ayaseh NA, Sawafta MN, Khdeir RL, Mezyed DO, Daraghmeh DN, Awang R. Use of complementary and alternative medicines in haemodialysis patients: a cross-sectional study from Palestine. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:204. [PMID: 27400742 PMCID: PMC4940841 DOI: 10.1186/s12906-016-1196-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 07/07/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Complementary and alternative medicine (CAM), and herbal therapies, are accepted worldwide, and have been important from medical, sociological and economic perspectives, among haemodialysis (HD) patients. The primary aim of this study was to evaluate the use of CAM among patients with end-stage renal disease (ESRD) who are undergoing HD. METHODS Face-to-face interviews of patients with ESRD undergoing HD from ten outpatient renal departments at a national level in Palestine were conducted from June 2014 to January 2015. A survey questionnaire, which included questions on socio-demographic and clinical characteristics, and on the CAM therapies that were used, was administered. RESULTS Out of 267 patients interviewed, 172 patients used at least one type of CAM in the last month prior to the interview, and thus the utilisation rate was 64.4 %. Forty one (15.4 %) patients reported using one type of CAMs, while 18.7 % used two different CAMs and 30.3 % used more than two types of CAMs for their health status. Of the patients who used CAM, herbal therapies were used most often (43.5 %), followed by honey (35.6 %), diet (22.8 %), and exorcism in Islam (16.9 %). The herbal therapies mentioned most often were Nigella sativa L. (18.7 %), followed by Salvia officinalis L. (16.9 %), and Pimpinella anisum L. (10.5 %). CONCLUSIONS In conclusion, the prevalence of CAM is relatively high in the selected population. Most patients used biological therapies such as herbal remedies, thus highlighting a greater need for patient education regarding CAM therapies and possible herb-drug interactions. Health care providers must be aware of the potential benefits and risks related to CAM use. There is a need for more clinical research pertaining to CAM to reach stronger evidence regarding potential benefits and risks related to CAM use.
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Affiliation(s)
- Sa’ed H. Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, 11800 Malaysia
| | - Samah W. Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Waleed M Sweileh
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ghada H. Tabeeb
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nora A. Ayaseh
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mayas N. Sawafta
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Razan L. Khdeir
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Diana O. Mezyed
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Dala N. Daraghmeh
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rahmat Awang
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, 11800 Malaysia
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Weir MR, Fink JC. Safety of medical therapy in patients with chronic kidney disease and end-stage renal disease. Curr Opin Nephrol Hypertens 2014; 23:306-13. [PMID: 24670404 DOI: 10.1097/01.mnh.0000444912.40418.45] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Maintaining patient safety is a necessary step to improve healthcare delivery. Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have an increased frequency of adverse safety events largely because of medication errors. RECENT FINDINGS CKD and ESRD have several features which threaten patient safety. Reduced glomerular filtration rate affects the clearance of many medications and is also associated with several comorbidities such as diabetes, cardiovascular disease, metabolic bone disease, and anemia. These comorbidities of CKD often increase the complexity of treatment regimens. Patients with ESRD, requiring dialysis or transplantation, have an even greater potential for adverse safety events because of the reliance on renal replacement modalities and the frequent requirements of polypharmacy and potential drug-drug interactions. SUMMARY There is an important need to develop strategies to provide inpatient and outpatient management plans to limit the risk of adverse medication errors across a wide range of educational and socioeconomic backgrounds, and a critical need to develop a uniform set of standards for evaluating patient safety in CKD and ESRD as well as appropriate descriptions of the prototypical safety profiles of patients who have CKD, a kidney transplant, or who are on dialysis.
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Affiliation(s)
- Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Ferraresi M, Clari R, Moro I, Banino E, Boero E, Crosio A, Dayne R, Rosset L, Scarpa A, Serra E, Surace A, Testore A, Colombi N, Piccoli BG. Reiki and related therapies in the dialysis ward: an evidence-based and ethical discussion to debate if these complementary and alternative medicines are welcomed or banned. BMC Nephrol 2013; 14:129. [PMID: 23799960 PMCID: PMC3694469 DOI: 10.1186/1471-2369-14-129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 06/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Complementary and Alternative Medicines (CAMs) are increasingly practiced in the general population; it is estimated that over 30% of patients with chronic diseases use CAMs on a regular basis. CAMs are also used in hospital settings, suggesting a growing interest in individualized therapies. One potential field of interest is pain, frequently reported by dialysis patients, and seldom sufficiently relieved by mainstream therapies. Gentle-touch therapies and Reiki (an energy based touch therapy) are widely used in the western population as pain relievers.By integrating evidence based approaches and providing ethical discussion, this debate discusses the pros and cons of CAMs in the dialysis ward, and whether such approaches should be welcomed or banned. DISCUSSION In spite of the wide use of CAMs in the general population, few studies deal with the pros and cons of an integration of mainstream medicine and CAMs in dialysis patients; one paper only regarded the use of Reiki and related practices. Widening the search to chronic pain, Reiki and related practices, 419 articles were found on Medline and 6 were selected (1 Cochrane review and 5 RCTs updating the Cochrane review). According to the EBM approach, Reiki allows a statistically significant but very low-grade pain reduction without specific side effects. Gentle-touch therapy and Reiki are thus good examples of approaches in which controversial efficacy has to be balanced against no known side effect, frequent free availability (volunteer non-profit associations) and easy integration with any other pharmacological or non pharmacological therapy. While a classical evidence-based approach, showing low-grade efficacy, is likely to lead to a negative attitude towards the use of Reiki in the dialysis ward, the ethical discussion, analyzing beneficium (efficacy) together with non maleficium (side effects), justice (cost, availability and integration with mainstream therapies) and autonomy (patients' choice) is likely to lead to a permissive-positive attitude. SUMMARY This paper debates the current evidence on Reiki and related techniques as pain-relievers in an ethical framework, and suggests that physicians may wish to consider efficacy but also side effects, contextualization (availability and costs) and patient's requests, according also to the suggestions of the Society for Integrative Oncology (tolerate, control efficacy and side effects).
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Affiliation(s)
- Martina Ferraresi
- SS Nephrology ASOU, san Luigi (regione Gonzole 10), Orbassano 10043, Torino, Italy.
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Kim EJ, Oh HA, Choi HJ, Park JH, Kim DH, Kim NJ. Heat-processed ginseng saponin ameliorates the adenine-induced renal failure in rats. J Ginseng Res 2013; 37:87-93. [PMID: 23717161 PMCID: PMC3659619 DOI: 10.5142/jgr.2013.37.87] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 09/17/2012] [Accepted: 09/25/2012] [Indexed: 11/18/2022] Open
Abstract
To evaluate the effect of the saponin of heat-processed ginseng (Sun ginseng, SG), we investigated the protective effect of SG total saponin fraction against adenine-induced chronic renal failure in rats. SG saponin significantly decreased the levels of urea nitrogen and creatinine in the serum, but increased the urinary excretion of urea nitrogen and creatinine, indicating an improvement of renal function. SG saponin also inhibited adenine-induced kidney hypertrophy and edema. SG saponin reduced serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and lactate dehydrogenase activities increased by adenine. Based on these findings, the ameliorating effect of SG on chronic renal failure may result from its saponin.
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Affiliation(s)
- Eun Jin Kim
- College of Pharmacy, Kyung Hee University, Seoul 130-701, Korea
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Luyckx VA. Nephrotoxicity of alternative medicine practice. Adv Chronic Kidney Dis 2012; 19:129-41. [PMID: 22578672 DOI: 10.1053/j.ackd.2012.04.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 04/06/2012] [Accepted: 04/09/2012] [Indexed: 11/11/2022]
Abstract
The use of alternative medicine is highly prevalent around the world; in many areas, this is so because of lack of access to, or trust in, Western medicine, and also because they are considered "natural" and therefore safe. The kidney is an organ vulnerable to toxic insults by virtue of its anatomy and function. Reports of nephrotoxicity associated with alternative medicine use encompass all forms of renal dysfunction, ranging from electrolyte abnormalities and proteinuria to acute and CKD, renal failure, and death. In countries where intensive care and dialysis support are not available, mortality is high. Mechanisms of alternative medicine-associated kidney injury include direct nephrotoxicity, which may be augmented by underlying predisposing conditions such as dehydration; contamination, or adulteration of remedies; inappropriate use or preparation of a remedy; or interactions with other medications. The use of alternative medicines is underreported to clinicians. Because many patients strongly believe in the powers of alternative medicines, it is important that alternative medicines not be demonized as a whole, but that their use and consequences be closely observed and reported to build a more comprehensive understanding of their impact in our clinical practice and to foster research on the potential harm or, in some cases, possible benefits.
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Brown AC. Anticancer Activity of Morinda citrifolia (Noni) Fruit: A Review. Phytother Res 2012; 26:1427-40. [DOI: 10.1002/ptr.4595] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 11/23/2011] [Indexed: 01/03/2023]
Affiliation(s)
- Amy C. Brown
- Department of Complementary and Alternative Medicine, John A. Burns School of Medicine; University of Hawaii at Manoa; 651 Ilalo Street, MEB 223; Honolulu; Hawaii; 96813
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Abstract
BACKGROUND Hepatic encephalopathy is a disorder of brain function as a result of liver failure and/or portosystemic shunt. Both hepatic encephalopathy (clinically overt) and minimal hepatic encephalopathy (not clinically overt) significantly impair patient's quality of life and daily functioning and represent a significant burden on health care resources. Probiotics are live microorganisms, which when administered in adequate amounts may confer a health benefit on the host. OBJECTIVES To quantify the beneficial and harmful effects of any probiotic in any dosage, compared with placebo or no intervention, or with any other treatment for patients with any grade of acute or chronic hepatic encephalopathy as assessed from randomised trials. SEARCH METHODS We searched the The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, conference proceedings, reference lists of included trials and the WHO international clinical trials registry until April 2011 registry platform to identify new and ongoing trials. SELECTION CRITERIA We included randomised trials that compared probiotics in any dosage with placebo or no intervention, or with any other treatment in patients with hepatic encephalopathy. DATA COLLECTION AND ANALYSIS Three authors independently assessed the risk of bias of the included trials and extracted data on relevant outcomes, with differences resolved by consensus. We conducted random-effects model meta-analysis due to obvious heterogeneity of patients and interventions. A P value of 0.05 or less was defined as significant. Dichotomous outcomes are expressed as risk ratio (RR) and continuous outcomes as mean difference (MD) with 95% confidence intervals (CI). MAIN RESULTS We included seven trials of which 550 participants were randomised. Four of the seven trials compared a probiotic with placebo or no treatment in 245 participants, another trial compared a probiotic with lactulose in 40 participants , and the remaining two trials compared a probiotic with both placebo and lactulose in 265 participants. Each trial used different types of probiotics. Duration of administration of the experimental intervention varied from 10 days to 180 days. Two trials were industry funded, and five were unclear about origin of funding. All trials had high risk of bias. When probiotics were compared with no treatment, there was no significant difference in all-cause mortality (2 trials, 105 participants; 1/57 (2%) versus 1/48 (2%): RR 0.72; 95% CI 0.08 to 6.60), lack of recovery (4 trials, 206 participants; 54/107 (50%) versus 68/99 (69%): RR 0.72; 95% CI 0.49 to 1.05), adverse events (3 trials, 145 participants; 2/77 (3%) versus 6/68 (9%): RR 0.34; 95% CI 0.08 to 1.42), quality of life (1 trial, 20 participants contributed to the physical quality of life measurement, 20 participants contributed to the mental quality of life: MD Physical 0.00; 95% CI -5.47 to 5.47; MD Mental 4.00; 95% CI -1.82 to 9.82), or change of/or withdrawal from treatment (3 trials, 175 participants; 11/92 (12%) versus 7/83 (8%): RR 1.28; 95% CI 0.52 to 3.19). No trial reported sepsis or duration of hospital stay as an outcome. Plasma ammonia concentration was significantly lower for participants treated with probiotic at one month (3 trials, 226 participants: MD -2.99 μmol/L; 95% CI -5.70 to -0.29) but not at two months (3 trials, 181 participants: MD -1.82 μmol/L; 95% CI -14.04 to 10.41). Plasma ammonia decreased the most in the participants treated with probiotic at three months (1 trial, 73 participants: MD -6.79 μmol/L; 95% CI -10.39 to -3.19). When probiotics were compared with lactulose no trial reported all-cause mortality, quality of life, duration of hospital stay, or septicaemia. There were no significant differences in lack of recovery (3 trials, 173 participants; 47/87 (54%) versus 44/86 (51%): RR 1.05; 95% CI 0.75 to 1.47), adverse events (2 trials, 111 participants; 3/56 (5%) versus 6/55 (11%): RR 0.57; 95% CI 0.06 to 5.74), change of/or withdrawal from treatment at one month (3 trials, 190 participants; 8/95 (8%) versus 7/95 (7%): RR 1.10; 95% CI 0.40 to 3.03), plasma ammonia concentration (2 trials, 93 participants: MD -6.61 μmol/L; 95% CI -30.05 to 16.84), or change in plasma ammonia concentration (1 trial, 77 participants: MD 1.16 μmol/L; 95% CI -1.96 to 4.28). AUTHORS' CONCLUSIONS The trials we located suffered from a high risk of systematic errors ('bias') and high risk of random errors ('play of chance'). While probiotics appear to reduce plasma ammonia concentration when compared with placebo or no intervention, we are unable to conclude that probiotics are efficacious in altering clinically relevant outcomes. Demonstration of unequivocal efficacy is needed before probiotics can be endorsed as effective therapy for hepatic encephalopathy. Further randomised clinical trials are needed.
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Affiliation(s)
- Richard G McGee
- Sydney School of Public Health, University of Sydney, Sydney, Australia.
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Nowack R, Ballé C, Birnkammer F, Koch W, Sessler R, Birck R. Complementary and Alternative Medications Consumed by Renal Patients in Southern Germany. J Ren Nutr 2009; 19:211-9. [DOI: 10.1053/j.jrn.2008.08.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Indexed: 11/11/2022] Open
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West BJ, Tolson CB, Vest RG, Jensen S, Lundell TG. Mineral variability among 177 commercial noni juices. Int J Food Sci Nutr 2007; 57:556-8. [PMID: 17162334 DOI: 10.1080/09637480601066794] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The popularity of noni juice is increasing globally. As such, knowledge of its nutritional properties is needed to make informed decisions regarding its use. This industry-wide mineral profile was determined by analyses of 177 brands of commercial noni juice according to a modified Association of Official Analytical Chemists protocol. A large degree of variability was found in the concentrations of nine minerals. While potassium was found to be the most prominent mineral, its concentration in most commercial brands is of minor nutritional significance. The wide variability among the many brands of commercial noni juice precludes the assumption that all are the same. Many have a different nutrient profile to that published by the European Union for Tahitian Noni Juice. Such variances may thus require consumers, dieticians, and other healthcare professionals to obtain unlabelled nutrient information from manufacturers.
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Affiliation(s)
- Brett J West
- Research and Development Department, Tahitian Noni International, American Fork, Utah 84003, USA.
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Ogborn MR, Nitschmann E, Bankovic-Calic N, Weiler HA, Aukema HM. Effects of flaxseed derivatives in experimental polycystic kidney disease vary with animal gender. Lipids 2006; 41:1141-9. [PMID: 17269560 DOI: 10.1007/s11745-006-5064-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Flaxseed derivatives, including both oil and flax lignan, modify progression of renal injury in animal models, including Han:SPRD-cy polycystic kidney disease (PKD). Gender is a significant factor in the rates of progression of many forms of human renal disease, but the role of gender in the response to nutrition intervention in renal disease is unexplored. In this study, male and female Han:SPRD-cy rats or normal littermates were fed either corn oil (CO) or flax oil (FO) diets, with or without 20 mg/kg of the diet flax lignan secoisolaricinoresinol dyglycoside (SDG). Renal injury was assessed morphometrically and biochemically. Renal and hepatic PUFA composition was assessed by GC and renal PGE2 release by ELISA. FO preserved body weight in PKD males, with no effect in females. SDG reduced weight in both normal and PKD females. FO reduced proteinuria in both male and female PKD. FO reduced cystic change and renal inflammation in PKD males but reduced cystic change, fibrosis, renal inflammation, tissue lipid peroxides, and epithelial proliferation in PKD females. SDG reduced renal inflammation in all animals and lipid peroxides in PKD females. A strong interaction between SDG and FO was observed in renal FA composition of female kidneys only, suggesting increased conversion of C18 PUFA to C20 PUFA. FO reduced renal release of PGE2 in both genders. Gender influences the effects of flaxseed derivatives in Han:SPRD-cy rats. Gender-based responses to environmental factors, such as dietary lipid sources and micronutrients, may contribute to gender-based differences in disease progression rates.
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Affiliation(s)
- Malcolm R Ogborn
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.
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