Role of Alternative Medical Systems in Adult Chronic Kidney Disease Patients: A Systematic Review of Literature

Abstract

There is a growing interest in the use of alternative medical systems (AMS), such as traditional Chinese medicine (TCM), ayurveda, homeopathy, and naturopathy, among chronic kidney disease patients. This review summarizes the efficacy and safety of AMS interventions in chronic kidney disease (CKD) patients. A systematic review was conducted in MEDLINE, Embase, Scopus, CINAHL, CENTRAL, and PsycINFO in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines. Randomized controlled trials (RCTs) which evaluated the use of AMS among adult CKD patients were included. The efficacy of each AMS was assessed based on improvement in biochemical markers or reduction in symptom severity scores. All adverse reactions were recorded. Of the 14,583 articles retrieved, 33 RCTs were included. TCM (n=20) and ayurveda (n=6) were the most well-studied. Majority of studies (66.7%) had a sample size <100. Common indications evaluated included improvement in renal function (n=12), proteinuria (n=5), and uremic pruritus (n=5). Among TCM, acupuncture and syndromes-based TCM granules formulation were shown to improve estimated glomerular filtration rate (eGFR) by 5.1-15.5% and 7.07-8.12% respectively. Acupuncture reduced uremic pruritus symptoms by 54.7-60.2% while Huangkui, Shenqi granules, and Tripterygium wilfordii Hook F reduced proteinuria by 18.6-50.7%, 61.8%, and 32.1% respectively. For Ayurveda, camel milk and Nigella sativa oil improved eGFR by 16.9% and 86.8%, respectively, while capsaicin reduced pruritus scores by 84.3%. Homeopathic verum medication reduced pruritus scores by 29.2-41.5%. Nausea was the most common adverse effect reported with alpha-keto amino acids (0.07%), Nigella sativa oil (7.04%), and silymarin (10%). TCM and ayurveda were more well-studied AMS therapies that demonstrated efficacy in CKD patients. RCTs with larger sample sizes are needed to ascertain the efficacy and safety of promising AMS.

Efficacy and safety of non-pharmacological therapy under the guidance of TCM theory in the treatment of anxiety in patients with myocardial infarction: A protocol for systematic review and meta-analysis

“…Our study will adhere to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines, with two independent evaluators systematically searching for articles published in PubMed, Embase, Ovid, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, China Integrated Knowledge Resources Database, Chinese scientific journals database, Chinese biomedical literature database, and Wanfang Database from their inception until December 31, 2022.The primary search terms will encompass "myocardial infarction", "anxiety", "anxiety state", “generalized anxiety disorder”, “GAD”, "traditional Chinese medicine", "non-pharmacological therapy", "acupuncture", "moxibustion", "massage", "qigong", "tai chi", "eight-section brocade", and "five animal frolics" [ 26 – 28 ]. The search strategy for PubMed is detailed in Table 1 .…”

“…anxiety disorder", "GAD", "traditional Chinese medicine", "non-pharmacological therapy", "acupuncture", "moxibustion", "massage", "qigong", "tai chi", "eight-section brocade", and "five animal frolics" [26][27][28]. The search strategy for PubMed is detailed in Table 1.…”

Complementary and alternative system of medicine for type 2 diabetes mellitus and its complications: A scoping review

“…For instance, systematic reviews assessing the efficacy of CAMs on chronic kidney diseases. 33,34 CAMs are also being evaluated for blood pressure control, chronic pelvic pain and symptom management in palliative cancer care. [35][36][37] Furthermore, it is recommended by the American Diabetes Association position statement that a CAMs can be used based on evidence from research.…”

Prevalence and varieties of complementary and alternative medicine usage among individuals with pre-dialysis chronic kidney disease in Taiwan: an investigative cross-sectional analysis

“…The average prevalence of CAM users in 32 countries is 26.4%, and it is as high as 50% in China, the Philippines and South Korea [ 11 ]. In certain scenarios, CAM has been noted to offer perceived advantages, including the capacity to manage illnesses, address the side effects of conventional medicine, and enhance the QOL and overall well-being, providing a sense of hope for individuals with CKD [ 12 – 15 ]. Nevertheless, a rigorous scientific evaluation of CAM is essential, focusing on its safety, effectiveness, and the quality of CAM treatments, as well as the availability of CAM therapies and their rational utilization [ 16 ].…”