Alternative and Integrative Therapies for HIV-associated Nephropathy (HIVAN)

General safety: Patients should consult their healthcare providers before beginning integrative treatments, especially if they recently received a kidney transplant.

Although chelation therapy may improve kidney function, it should be avoided in HIV patients because it may further weaken the patient's immune system.

Good Scientific Evidence :

Chelation therapy : During chelation therapy, EDTA (ethylenediamine tetraacetic acid), usually in combination with vitamins, trace elements, and iron supplements, is injected into the vein as a treatment for a variety of diseases. Several studies support use of EDTA chelation for reduction of lead toxicity associated with chronic kidney insufficiency and suggest it may slow progression of the disorder. More studies are needed to confirm these findings, but EDTA chelation can be considered as a useful adjunctive therapy in treatment of chronic kidney insufficiency. It is important to note that all reported that the same investigator conducted the trials. However, chelation therapy should be avoided in HIV patients because it may further weaken the immune system.

Rhubarb : In traditional Chinese medicine (TCM), rhubarb is used as an ulcer remedy and it is considered a bitter, cold, dry herb used to "clear heat" from the liver, stomach, and blood. Rhubarb has shown positive effects on kidney failure in the lab and it seems promising in human studies. In some studies, rhubarb is more effective than captopril and rhubarb combined with captopril is more effective than either substance alone. Higher quality studies are necessary to confirm this hypothesis.

Avoid if allergic/hypersensitive to rhubarb, its constituents, or related plants from the Polygonaceae family. Avoid using rhubarb for more than two weeks because it may induce tolerance in the colon, melanosis coli, laxative dependence, pathological alterations to the colonic smooth muscles, and substantial loss of electrolytes. Avoid with atony, colitis, Crohn's disease, dehydration with electrolyte depletion, diarrhea, hemorrhoids, insufficient liver function, intestinal obstruction or ileus, irritable bowel syndrome, menstruation, pre–eclampsia, kidney disorders, ulcerative colitis, and urinary problems. Avoid handling rhubarb leaves, as they may cause contact dermatitis. Avoid rhubarb in children under age 12 due to water depletion. Use cautiously with bleeding disorders, cardiac conditions, coagulation therapy, constipation, history of kidney stones, or thin or brittle bones. Use cautiously if taking anti–psychotic drugs or oral drugs, herbs, or supplements (including calcium, iron, and zinc). Avoid if pregnant or breastfeeding.

Unclear or Conflicting Scientific Evidence :

Acupuncture : Acupuncture originated 5,000 years ago in China. Today, it is commonly used throughout the world. Chinese medicine theory holds that the human body contains a network of energy pathways through which vital energy, called "chi" (also spelled "qi"), circulates. There has been limited research on acupuncture for kidney disorders. Currently, there is no adequate available evidence to recommend for or against acupuncture in these conditions.

Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, or with drugs that increase the risk of bleeding (anticoagulants). Avoid with medical conditions of unknown origin and neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or in patients with a history of seizures. Avoid electroacupuncture with patients who have irregular heartbeats or in patients with pacemakers.

Astragalus : In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. Western herbalists began using astragalus in the 1800s as an ingredient in various tonics. Several animal and human studies report that kidney damage from toxins and kidney failure may be improved with the use of astragalus–containing herbal mixtures. Overall, this research has been poorly designed and reported. Astragalus alone has not been well evaluated. Better quality research is necessary before a conclusion can be drawn.

Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark–induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplant, or autoimmune diseases. Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders due to increased excretion of sodium and chloride. Use cautiously with blood–thinners, drugs that alter blood sugar levels, diuretics, or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.

Coenzyme Q10 : Coenzyme Q10 (CoQ10) is produced by the human body and it is necessary for basic functioning of cells. CoQ10 levels decrease with age. There is initial data to support the use of CoQ10 in the treatment of kidney failure. More research is needed before a firm conclusion can be made.

There have not been any reported cases of allergic reactions to Coenzyme Q10 supplements, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use cautiously with history of blood clots, diabetes, high blood pressure, heart attack, or stroke. Use cautiously with blood thinners, antiplatelet drugs (like aspirin, warfarin, clopidogrel), blood pressure drugs, blood sugar drugs, cholesterol drugs or thyroid drugs. Avoid if pregnant or breastfeeding.

Cordyceps : Cordyceps is a genus of parasitic ascomycete fungi. Cordyceps sinensis, the cordyceps species most widely used as a dietary supplement, naturally grows on the back of the larvae of a caterpillar from the moth Hepialus armoricanus Oberthur found mainly in China, Nepal, and Tibet. In traditional Chinese medicine (TCM), cordyceps is used to strengthen kidney function. Two studies indicate that cordyceps may improve renal function in patients with chronic renal failure. More studies are needed to confirm these findings.

Avoid if allergic or hypersensitive to cordyceps, mold, or fungi. Use cautiously with diabetes, bleeding disorders, or prostate conditions. Use cautiously if taking anticoagulants, immunosuppressants, hormonal replacement therapy, or oral contraceptives. Avoid with myelogenous type cancers. Avoid if pregnant or breastfeeding.

Creatine : Creatine is often used as a bodybuilding supplement. It remains unclear whether creatine is a beneficial treatment for patients undergoing dialysis. Further research is needed before a firm conclusion can be made.

Avoid if allergic to creatine or with diuretics (like hydrochlorothiazide, furosemide (Lasix ®)). Use cautiously with asthma, diabetes, gout, kidney, liver disorders, muscle problems, stroke, or with a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.

Danshen : Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. Although early evidence is promising, it is not known whether danshen is safe for kidney disorders. Danshen injection may be helpful for recovery of kidney function after kidney transplant. Further research is needed to confirm these results.

Avoid if allergic or hypersensitive to danshen. Use cautiously with sedatives or hypolipidemics, cardiac glycosides, CYP–metabolized agents, nitrate ester, steroidal agents, and some anti–inflammatories (like ibuprofen). Use cautiously with altered immune states, arrhythmia, compromised liver function, or a history of glaucoma, stroke, or ulcers. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin, or hypotensives including ACE inhibitors (like captopril), Sophora subprostrata root, or herba serissae. Avoid with bleeding disorders, low blood pressure, and following cerebral ischemia. Avoid if pregnant or breastfeeding.

Flaxseed : Flaxseed and flaxseed oil/linseed oil are rich sources of the essential fatty acid alpha–linolenic acid (omega–6). Some animal studies and low–quality human studies suggest that flaxseed may be an effective treatment for kidney diseases. However, more research is needed before flaxseed (not flaxseed oil) can be recommended for a kidney disease called nephritis.

Flaxseed has been well tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil, or other plants of the Linaceae family. Avoid with prostrate cancer, breast cancer, uterine cancer, or endometriosis. Avoid ingestion of immature flaxseed pods. Avoid large amounts of flaxseed by mouth and mix plenty of water or liquid. Avoid flaxseed (not flaxseed oil) with history of esophageal stricture, ileus, gastrointestinal stricture, or bowel obstruction. Avoid with history of acute or chronic diarrhea, irritable bowel syndrome (IBS), diverticulitis, or inflammatory bowel disease. Avoid topical flaxseed in open wounds or abraded skin surfaces. Use cautiously with history of bleeding disorders or with drugs that increase the risk of bleeding (like anticoagulants and non–steroidal anti–inflammatory drugs). Use cautiously with high triglyceride levels, diabetes, mania, seizures, or asthma. Avoid if pregnant or breastfeeding.

Omega–3 fatty acids : Omega–3 fatty acids are found in fish oil and certain plant/nut oils. There is not enough scientific data available to recommend omega–3 fatty acids for the treatment of kidney disorders.

Avoid if allergic or hypersensitive to fish, omega–3 fatty acid products that come from fish, nuts, linolenic acid, or omega–3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or drugs, herbs, or supplements that treat any such conditions. Use cautiously before surgery. Pregnant or breastfeeding women should consult a qualified healthcare provider to determine the proper intake of omega–3 fatty acids.

Prayer : Prayer can be defined as a "reverent petition," the act of asking for something while aiming to connect with God or another object of worship. Prayer on behalf of the ill or dying has played a prominent role throughout history and across cultures. Metaphysical explanations and beliefs often underlie the practice of prayer. Preliminary research shows positive trends associated with prayer and spirituality in patients with end stage renal disease (ESRD) who are coping after kidney transplant. Further research is needed before conclusions can be drawn.

Prayer is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches and require an open dialog between patients and caregivers.

Psychotherapy : Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient will explore thoughts, feelings and behavior to help with problem solving. Although individual and group psychotherapy may both decrease depression associated with a kidney transplant, individual therapy may be more effective than group therapy. More research needs to be done in this area.

Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.

Reishi mushroom : Reishi mushroom (Ganoderma lucidum), also known as Ling Zhi in China, grows wild on decaying logs and tree stumps. Preliminary research suggests that reishi mushroom (Ganoderma lucidum) may help treat kidney disorder in patients who have persistently high levels of protein in the urine that does not respond to other treatment. However, further research is needed to confirm these results.

Avoid if allergic or hypersensitive to any constituents of Ganoderma lucidum or any member of its family. Use cautiously with diabetes, blood disorders (including hemophilia), low blood pressure, or ulcers. Avoid if pregnant or breastfeeding.

Selenium : Selenium is a mineral found in soil, water, and some foods. Dialysis may lower levels of selenium in the blood. It remains unclear whether supplementation with selenium is a beneficial treatment for patients undergoing dialysis.

Avoid if allergic or sensitive to products containing selenium. Avoid with history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.

Safflower : Safflower oil can be taken by mouth, injected, or applied to the skin. In the United States, safflower oil has been frequently substituted for oils with higher saturated fat content. Although safflower has been suggested as a possible treatment for kidney disorders, further research is needed before a firm conclusion can be made.

Avoid if allergic/hypersensitive to safflower, Carthamus tinctorius, safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any related constituents. Use injection safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants (blood thinners), anti–platelet drugs, immunosupressants, or pentobarbital. Use cautiously with diabetes, low blood pressure, inadequate liver function, hypercoagulability, and skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.

Soy : Soy has been suggested for many conditions, including high cholesterol, cardiovascular health, menopausal symptoms, and diarrhea. Due to limited human studies, there is not enough evidence to recommend for or against the use of soy in the treatment of kidney diseases, such as acute interstitial nephritis. People with kidney disease should speak to their healthcare providers about recommended amounts of dietary protein and should bear in mind that soy is a high protein food.

Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, such as increased risk of blood clots. The use of soy is often discouraged in patients with hormone–sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone–sensitive conditions, such as endometriosis, may also be worsened. Patients taking blood–thinners, such as warfarin, should check with their healthcare providers and pharmacists before taking soy supplementation.

Zinc : Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Zinc is needed for the functioning of over 300 different enzymes. It plays a vital role in a large number of biological processes. Preliminary research shows a potential improvement in uremic patients taking zinc supplements. Further research is needed to confirm these results. Zinc supplementation may be recommended only in the patients with proven zinc deficiency, but for all chronic kidney failure patients it is questionable.

Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.

Fair Negative Evidence :

Arginine (L–arginine) : L–arginine helps maintain the body's fluid balance (urea, creatinine) and aids in wound healing, hair growth, sperm production (spermatogenesis), blood vessel relaxation (vasodilation), and helps fight infection. It has been suggested that arginine may be a useful supplement in people diagnosed with kidney failure. However, results from available studies do not support this claim. A small randomized, controlled clinical trial studied the ability of L–arginine to improve dilation of blood vessels in children with chronic kidney failure. Results showed that blood vessel dilation (endothelial function) was not improved with oral L–arginine suggesting that dietary supplementation is not a beneficial or useful clinical approach in children with chronic renal failure.

Avoid if allergic to arginine or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood–thinners (like warfarin) and blood pressure drugs or herbs or supplements with similar effects. Check blood potassium levels.

Iridology : Iridology is the study of the iris for diagnostic purposes that developed more than 100 years ago and assumes that all bodily organs are represented on the surface of the iris via intricate neural connections. Conventional medicine regards iridology as an unsubstantiated alternative diagnostic technique, although some studies have suggested it may have some potential validity. Preliminary study submitted photographs of irises of kidney disease patients to practicing iridologists and found no evidence of accurate detection of kidney disease. There is no evidence supporting iridology as a diagnostic tool in kidney disease.

Iridology should not be used alone to diagnose disease. Studies of iridology have reported incorrect diagnoses, and potentially severe medical problems may thus go undiagnosed. In addition, research suggests that iridology may lead to inappropriate treatment.

Comments (0)