A Review of Dietary Supplement–Induced Renal Dysfunction

Abstract

Complementary and alternative medicine (CAM) is a multibillion-dollar industry. Almost half of the American population uses some form of CAM, with many using them in addition to prescription medications. Most patients fail to inform their health care providers of their CAM use, and physicians rarely inquire. Annually, thousands of dietary supplement-induced adverse events are reported to Poison Control Centers nationwide. CAM manufacturers are not responsible for proving safety and efficacy, because the Food and Drug Administration does not regulate them. However, concern exists surrounding the safety of CAM. A literature search using MEDLINE and EMBASE was undertaken to explore the impact of CAM on renal function. English-language studies and case reports were selected for inclusion but were limited to those that consisted of human subjects, both adult and pediatric. This review provides details on dietary supplements that have been associated with renal dysfunction and focuses on 17 dietary supplements that have been associated with direct renal injury, CAM-induced immune-mediated nephrotoxicity, nephrolithiasis, rhabdomyolysis with acute renal injury, and hepatorenal syndrome. It is concluded that it is imperative that use of dietary supplements be monitored closely in all patients. Health care practitioners must take an active role in identifying patients who are using CAM and provide appropriate patient education.

Chaparral Induced Renal Failure

“…Data has suggested that only 38.5% of CAM use was reported to the physicians [9][10][11] and only 12% of CAM users have sought care from a licensed physician [12]. There were 629 million visits to alternative medicine practitioners in 1997, more than total number of visits to all U.S. primary care visits [11].…”

Finding a Common Language for Patient Safety in CKD

“…The broad range of potentially harmful medications in CKD and their mechanisms of toxicity have been reviewed extensively (27)(28)(29)(30). Various nutritional supplements, herbals, and over-the-counter supplements also have been shown to exhibit nephrotoxicity (31)(32)(33), and their use by patients is often underreported to practitioners (34). Moreover, the risk for medication toxicity is only amplified in patients with CKD, whose substantial polypharmacy leads to increased opportunities for medication mishaps (11,35).…”

Weight Loss Supplements: Boon or Bane?

“…OxyELITE Pro TM (OEP) supplements contain a compound aegeline with anti-adipogenic features which was known to cause hepatocellular patterns of injury in consumers (5). Chinese herbal supplements for weight loss contain Aristolochic acid, which is notorious for causing urothelial carcinoma, renal intestinal fibrosis and loss of cortical nephrons (4,8). In patients with cardiovascular diseases, garlic, ginger, grapefruit juice and green tea, which are used for weight loss, are known to decrease the effects of warfarin, and cause hypotension and liver toxicity respectively (14).…”

“…In patients with cardiovascular diseases, garlic, ginger, grapefruit juice and green tea, which are used for weight loss, are known to decrease the effects of warfarin, and cause hypotension and liver toxicity respectively (14). Chromium picolinate (CP) is widely used for its lipid lowering and weight loss properties, and is known to produce acute kidney failure due to acute tubular necrosis warranting haemodialysis (8). Patients with known conditions such as diabetes, hypertension or coronary artery disease might develop renal disease due to these supplements (4).…”