Traditional and complementary medicine use among chronic haemodialysis patients: a nationwide cross-sectional study

Abstract

Background In the era of digital and improved conventional medicine, many continue to use traditional and complementary medicine (TCM). The prevalence of its usage is not well reported, especially in patients with end-stage kidney disease (ESKD) receiving haemodialysis, thus its benefits and adverse effects are not widely known. This study determines the prevalence, types, perceptions and factors associated with TCM use by chronic haemodialysis patients in Malaysia. Methods This is a multi-centre cross-sectional study involving patients undergoing haemodialysis treatment in Malaysia. A validated face-to-face questionnaire-based interview was conducted. Sociodemographic and clinical profiles of the patients, factors associated with TCM use, perceptions, sources of information, and disclosures to treating doctors were obtained. Data were analysed using SPSS software. Results A total of n = 329 participants were recruited. The mean age of the participants was 54.9 ± 12.5 years. The majority were Malays (72%) and females (54.7%). A total of 64.7% (n = 213) reported TCM use; n = 132 used TCM before the initiation of dialysis, while n = 81 used TCM after initiation. In the post-hoc analysis, patients who had never used TCM had a higher mean age (56.7 ± 12.3 years) than the patients who used TCM (51.1 ± 13.1) (p = 0.015) and were likely to have received primary education (p = 0.011). Unemployment was more likely to be associated with non-TCM use; with odds ratio 1.85 (95% CI: 1.15, 2.98). Biologically based therapy was found to be the most popular (97.2%) type of TCM, including herbal medicine (67.6%) and supplements (58.0%). Most respondents did not disclose their TCM use to their doctors (72.3%), and 41.8% had the perception that they felt better. Conclusions TCM is widely used among chronic haemodialysis patients in Malaysia, mainly herbal medicine and supplements. Non-disclosure to healthcare professionals and a poor monitoring and regulation of its use in ESKD patients could be detrimental. Awareness needs to be raised among healthcare professionals and the general population. Trial registration The Ethics Committee for Research, University Putra Malaysia (13th March 2019). Reference: UPM/TNCPI/RMC/1.4.18.2 (JKEUPM).

Frequency, types, and factors associated with complementary and alternative medicine use among patients on maintenance haemodialysis

“…We observed that most of the CAM use was undisclosed to the treating physician, as has been reported previously [ 19 , 20 , 23 ]. The reasons for this attitude include the assumption that their physician would disapprove of it (38.2%) or that the physician did not believe in it (33.3%).…”

“…This high prevalence of CAM use in our setting probably reflects the high prevalence of CAM use in the general population. Indeed, the prevalence of CAM use varies according to the cultural beliefs and practices of different populations [ 19 ]. Among the general population in Cameroon, the prevalence of CAM use was reported to be 80%, similar to our results [ 12 ].…”

“…The modalities of CAM therapies are classified into four categories as in Zakaria et al’s study [ 4 ]. These are divided into biologically based therapies, manipulative body-based therapies, mind-body interventions, and alternative medical systems.…”

“…To control and cope with their symptoms and improve their quality of life, many turn to complementary and alternative medicine (CAM). However, the use of CAM among this subpopulation is of great concern, as biologically based therapies which are the most widely used CAM modalities worldwide, seem to pose a greater risk to this population than to the general population [ 4 ]. This is mainly due to the poor excretory function that could alter pharmacokinetics and pharmacodynamics leading to increased toxicity, a greater chance of drug interactions, and potentially lethal electrolyte abnormalities [ 5 ].…”

“…CAM is defined as any medical and health care systems, practices, or products that are not thought of as standard medical care [ 6 ]. There is increasing use of CAM worldwide particularly in low- and middle-income countries, with claims of its benefits and non-nocive nature compared to conventional medicine [ 4 ]. The reported global prevalence of CAM use in the general population ranges from 10 to 94% with wide variation due to factors such as differences in the population characteristics, response rates, CAM definitions used, and study methodology.…”