ASN: Kidney Patients Using Harmful Dietary Supplements

By Charles Bankhead, Staff Writer, MedPage Today Published: November 12, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner PHILADELPHIA -- From 10% to 15% of patients with chronic kidney disease reported using potentially nephrotoxic dietary supplements, an analysis of a large government database showed. Overall, 52.4% of 21,169 survey respondents reported using dietary supplements. The likelihood of self-reported supplement use was increased among individuals with chronic kidney disease. Total supplement use included substances identified as potentially nephrotoxic by the National Kidney Foundation in 15.3% of cases.
Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Explain that from 10% to 15% of patients with chronic kidney disease reported using potentially nephrotoxic dietary supplements.

Point out that according to the study, more than half of American adults use dietary supplements.

Self-reported use of the potentially harmful supplements declined from 16.1% of individuals with no kidney disease to 13.0% of those with stage 1-2 chronic

kidney disease to 10.0% of those with stage 3-4 kidney disease, Vanessa Grubbs, MD, reported here at the American Society of Nephrology (ASN) meeting. "Although the raw numbers were a little bit lower among people who had kidney disease, when we accounted for things like age, gender, and education, people who had kidney disease were as likely to be taking a potentially harmful dietary supplement as those who had no kidney disease at all," Grubbs, of the University of California San Francisco, said during an ASN press briefing. "This is important because people who have kidney disease, the vast majority are not aware they have kidney disease. Even among people who have advanced kidney disease, less than 10% are aware that they have kidney disease." "People are taking these supplements because they think they are improving their health," she added "The fact that the supplements can cause harm that is entirely preventable also is an important point." The study evolved from the recognition that chronic kidney disease constitutes a growing problem in the United States, currently affecting an estimated 26 million adults, including 500,000 patients on dialysis, said Grubbs. Any steps that can be taken to minimize the risk would have major health and economic implications. The National Kidney Foundation has identified 39 herbal supplements that have the potential to harm the kidneys. Using that list, Grubbs and colleagues analyzed data from the National Health and Nutrition Examination Survey (NHANES) for the years 1999 to 2008. They identified 21,169 participants who reported on their supplement use within the past 30 days and whose kidney function was known. The investigators defined stage 1-2 chronic kidney disease as an albumincreatinine ratio 30 g with an estimated glomerular filtration rate (eGFR) 60 mL/min/1.73 m2 and stage 3-4 kidney disease as an eGFR of 15 to 59 mL/min/1.73 m2. The proportion of NHANES participants taking supplements was 51.4% among individuals without CKD, 49.1% for individuals with stage 1-2 kidney disease, and 65.8% for respondents with stage 3-4 kidney disease (P<0.001). An adjusted analysis showed no difference among the groups in the proportion reporting use of any herbal supplement. Patients with kidney disease were significantly less likely to use potentially harmful dietary supplements as compared with NHANES respondents without kidney disease (P<0.001). After adjustment, however, the difference disappeared (OR 0.97, 95% CI 0.3-1.28 for stage 1-2 kidney disease, OR 0.90, 95% CI 0.67-1.21 for stage 3-4).

"The use of dietary supplements that are potentially harmful in chronic kidney disease is common and, as use is not statistically different by disease status, patients with chronic kidney disease may be unaware of the risk," said Grubbs. "Healthcare providers, too, may be unaware of potentially harmful supplements and that patients with chronic kidney disease are taking them."
Grubbs had no disclosures. Coauthors disclosed links with Forest Research Institute, Arbor Research Collaborative, Amgen, the Foundation for Anemia Research, the American Board of Internal Medicine, Vanderbilt University, and the American Society of Nephrology.

Primary source: American Society of Nephrology Source reference: Grubbs V et al. "Prevalent use of dietary supplements potentially harmful in chronic kidney disease in the United States" ASN 2011; Abstract TH-PO267.