Complementary and alternative medicine is a multibillion-dollar industry made popular by people looking for improved well-being. This effort can be done with or without guidance from a health care provider.
Many people look to dietary and herbal supplements for a healthier lifestyle. There is a perception that herbals, vitamins and minerals are harmless or safer than pharmaceuticals because these are “natural.”
The recent recall by TruVision Health LLC of various nutritional supplements brings into question the safety of these products for patients with kidney disease. The supplements contained unapproved ingredients hordenine and/or octodrine dimethylhexylamine, which behave as stimulants, and are possibly unsafe and are not permitted to be sold.
Patients with kidney disease are more vulnerable to the unseen harm of supplements, which can contribute to kidney damage (see Table 1). A published review by Gabardi and colleagues examined reported cases of dietary supplement-induced renal dysfunction in humans. They found 17 dietary supplements associated with complementary and alternative medicine (CAM)-induced immune-mediated nephrotoxicity, nephrolithiasis, rhabdomyolysis with AKI and hepatorenal syndrome. In some cases, the renal dysfunction was diagnosed either through renal biopsy or clinical observation.
Creatine may be the most controversial of these offenders as there are several small-scale trials that argue against nephrotoxicity of creatine supplementation. However, there have been at least two reported cases in which the consumer acquired renal dysfunction from acute focal interstitial nephritis and tubular injury with a 2 g to 5 g per day dose of creatine. One patient had a previous existing condition of focal segmental glomerulosclerosis. It is important to assess for CAM in patients at higher risk for renal injury from common supplements used for exercise performance.
There have been cases in which chromium picolinate supplementation dosing and product purity may have played a role in kidney injury.
Renal dysfunction has been reported due to kidney stones/oxalate formation with ascorbic acid (vitamin C) and vaccinium macrocarpon (cranberry). Vitamin C supplementation is commonly used to enhance wound healing or iron absorption and for benefiting immune system resiliency. Cranberry tablets are commonly used to prevent or treat bladder and urinary tract infections. A 450 mg concentrated cranberry tablet contains approximately 180 mg of oxalate.
In a study by Terris and colleagues, an analysis of urine samples saw an increase of oxalate excretion by 43.3% after cranberry tablet ingestion. Cranberry and vitamin C supplements may increase risk for calcium-oxalate stone formation.
Supplements like licorice, that have diuretic properties, have been associated with severe hypokalemia. Others include kava, aloe vera, creatine, ephedra,