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  • Columbia Care Celebrates Launch of Adult Use Cannabis Sales in Missouri | News

    Columbia Care Celebrates Launch of Adult Use Cannabis Sales in Missouri | News

    NEW YORK–(Enterprise WIRE)–Feb 6, 2023–

    Columbia Care Inc. (NEO: CCHW) (CSE: CCHW) (OTCQX: CCHWF) (FSE: 3LP) (“Columbia Care” or the “Company”), just one of the premier and most experienced cultivators, manufacturers and stores of hashish goods in the U.S., introduced it commenced adult-use profits on February 4 at its Cannabist i dispensary, situated in Hermann, Missouri. The dispensary has been serving the clinical affected person group considering the fact that 2021.

    “We are thrilled to see the swift action taken by the Department of Health and Senior Companies to bring leisure hashish to Missourians so before long after the ballot measure passed in November. It has been a privilege to run in these types of a promptly escalating marketplace and serve our patients in the neighborhood Hermann group. We search ahead to welcoming new buyers as a result of our doorways in the coming weeks and introducing them to our Cannabist experience,” reported Jesse Channon, Main Expansion Officer, Columbia Treatment.

    Cannabist Hermann presents a extensive selection of solutions as well as manufacturers, which include Columbia Care’s Amber, Classix, Hedy and Seed & Pressure. In addition to its dispensary in Hermann, the Firm also operates a producing facility in nearby Columbia, Missouri, which produces vapes, edibles and pre-rolls.

    For much more data, pay a visit to https://gocannabist.com/hermann.

    i Cannabist Hermann is managed by Columbia Treatment, LLC on behalf of Columbia Care MO, LLC by way of a managed providers arrangement.

    About Columbia Care

    Columbia Care is 1 of the premier and most seasoned cultivators, makers and vendors of hashish goods and connected providers, with licenses in 18 U.S. jurisdictions. Columbia Care operates 128 services which includes 95 dispensaries and 33 cultivation and producing facilities, together with people beneath enhancement. Columbia Care is one particular of the initial multi-state vendors of health-related cannabis in the U.S. and now delivers industry-foremost goods and expert services to equally the medical and grownup-use markets. In 2021, the firm introduced Cannabist, its new retail brand, creating a national dispensary network that leverages proprietary know-how platforms. The business features goods spanning flower, edibles, oils and tablets, and manufactures popular models including Seed & Strain, Triple Seven, Hedy, gLeaf, Classix, Push, and Amber. For more information on Columbia Treatment, you should visit www.columbia.care.

    Caution About Ahead-Hunting Statements

    This push launch has certain statements that constitute “forward-looking information” or “forward-on the lookout statements” within the indicating of relevant securities laws and reflect the Company’s present-day expectations concerning future activities. Ahead-searching statements or information and facts contained in this release include, but are not restricted to, statements or info with regard to the Company’s ability to execute on retail, wholesale, manufacturer and product or service initiatives. These ahead-wanting statements or details, which even though considered sensible by the Firm, could verify to be incorrect and are matter to recognised and unknown hazards and uncertainties that may well result in actual outcomes, performance or achievements of the Firm to be materially various from those people expressed or implied by any ahead-wanting information. These risks, uncertainties and other factors include things like, amid other folks, favorable running and financial disorders acquiring and retaining all expected licenses and permits favorable manufacturing amounts and sustainable expenses from the Company’s functions and the amount of demand for hashish products and solutions, such as the Company’s items bought by third functions. In addition, securityholders ought to assessment the danger factors mentioned underneath “Risk Factors” in Columbia Care’s Kind 10 dated May perhaps 9, 2022, filed with the applicable securities regulatory authorities and described from time to time in documents submitted by the Firm with Canadian and U.S. securities regulatory authorities.

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    Marketplace Search phrase: Alternate Medication Cannabis Health and fitness Buyer Women of all ages All-natural Sources Gentlemen

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

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

    Chronic kidney disease (CKD) is one of the leading causes of death globally, which affects 13.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the world’s population [1]. With deterioration in renal function, this leads to the onset of CKD-related complications, such as uremia, anemia, and electrolyte disorders [2]. These complications often manifest as symptoms ranging from pruritus, pain, and insomnia to muscle cramps. This in turn has negative implications on patients’ quality of life [3,4]. Importantly as CKD patients approach end-stage renal disease (ESRD), the prevalence and severity of such symptoms increase [5].

    Despite medical breakthroughs and the advent of new therapies in the past decades, optimal treatments for some of the symptoms resulting from CKD-related complications remained unclear, possibly due to their complex pathophysiology. A case in point is uremic pruritus, which is found in around 20{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of pre-dialysis CKD patients and 40{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of ESRD patients [6]. Although prevalent treatments include the use of emollients, gabapentin, and antihistamines, data related to their efficacy were often derived from small studies and their use is limited by adverse effects [7].

    The use of alternative medical systems (AMS) which forms a key pillar of complementary and alternative medicine (CAM) has increased in the past 20 years [8]. AMS is defined as “entire systems of health theory and practice that developed separately from conventional medicine” [9]. Notably, around 18{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of dialysis patients have utilized some form of AMS [10,11]. In addition, prescription of AMS therapies such as traditional Chinese medicine (TCM) by professional practitioners often aids in minimizing the risk of side effects, hence increasing their appeal as potential therapeutic alternatives [11].

    Prior studies have shown that AMS is effective in reducing symptoms such as pain, nausea, and fatigue in non-CKD patient populations. For instance the use of TCM formulas, such as Liu Junzi Tang and Xiao Banxia Plus Fuling have demonstrated efficacy in treating cancer-related pain and chemotherapy-related nausea and vomiting [12]. In addition, Chinese herbs such as Curcuma longa and Panax ginseng among patients with malignancies have shown efficacy in promoting apoptosis of cancer cells and inhibiting tumor metastasis [13]. Another study showed that a multi-modal Ayurvedic treatment approach was effective in reducing knee osteoarthritis symptoms, such as pain and stiffness, and improving function [14]. With increasing research supporting the use of AMS, this has led to a rise in healthcare institutions adopting and providing such integrated services which are supported by insurance coverage [15].

    Among CKD patients, multiple studies have also been conducted to assess the efficacy of AMS in the treatment of CKD-related conditions and symptoms such as uremic pruritis and anemia. For instance, a study that assessed the efficacy of homeopathy verum among CKD patients showed a reduction in pruritus symptoms by 49{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} after 30 days of treatment [16]. Another study that evaluated the use of TCM patients with glomerulonephritis showed improvement in hemoglobin after 24 weeks of therapy [16,17].

    Existing reviews which have assessed the role of AMS are currently limited to specific indications, such as uremic pruritus [18], use of subtypes of AMS in specific CKD subgroups, such as consumption of Chinese herbal medicine in diabetic kidney disease [19], and specific AMS therapies, such as use of Astragalus [20,21]. This review aimed to summarize and evaluate the broad roles and efficacy of AMS as potential alternative therapeutic options for CKD patients. Findings from the review will aid physicians in gaining a better understanding of the efficacy of AMS for CKD patients, which can aid in facilitating purposeful discussions with patients who are using or considering these therapies.

    Methods

    Protocol and Registration

    The protocol for this study was registered on Open Science Framework (https://osf.io/ymks8/) and was composed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Synthesis without Meta-Analysis (SWiM) reporting guidelines [22,23].

    Information Sources and Search

    A literature search was conducted in MEDLINE, Embase, Scopus, CENTRAL, CINAHL, and PsycINFO. There was no start date restriction, and studies up to April 2022 were included. Key terms related to CKD, randomized controlled trials (RCT), and AMS were included in the searches. The search terms were adapted from other systematic reviews and the full search strategy is available in Appendix 1 [18,24-26].

    Eligibility Criteria

    With regards to inclusion criteria, full-text articles in English language which involved RCTs evaluating the use of AMS in adult CKD patients (>18 years old) were included. As defined by the National Center for Complementary and Integrative Health (NCCIH), AMS is a broad category encompassing a variety of medical modalities and refers to an entire system of theory and practice which developed separately from conventional medicine [15]. In this review, we included TCM, naturopathy, homeopathy, and ayurvedic medicine. Non-RCTs, case series, other systematic reviews, and meta-analyses were excluded.

    Description of Main Types of AMS

    TCM: TCM is a system of medical practice which originated in China and adopts a holistic approach to the medical treatment of a patient based on “syndrome differentiation.” It focuses on the integrity of the human body by emphasizing the intimate relationship between the body and its social and natural environment, as well as dynamic balance of movement [27]. The basic tenet of TCM is based on the flow and balance of vital energy, Qi, which flows through channels in the body called meridians that connect various organs and tissues [28]. Diseases are believed to be brought about by the imbalance of Qi. Hence, by restoring balance via acupoints or intake of herbs, TCM seeks to promote individual wellness and prevent diseases [29].

    Naturopathy: Naturopathy is a form of medical practice which is rooted in vitalism and folk medicine and, promotes natural and self-healing ideologies [30]. The unique attribute of naturopathic medicine lies in the reprioritization of the order of therapeutics with increased emphasis on preventive behaviors, lifestyle modifications, nutrition, and exercise, over medical or surgical interventions [31].

    Homeopathy: Homeopathy entails the therapeutic administration of substances derived from plants, minerals, or animals that produce effects that correspond to the clinical manifestation of diseases [32]. Its practice is centered on two following theories: “like cures like” and “law of minimum dose.” “Like cures like” refers to the belief that diseases can be treated with substances that produce similar symptoms in healthy individuals, and “law of minimum dose” refers to the belief that the lower the dose the greater its therapeutic efficacy [32].

    Ayurvedic medicine: Ayurvedic medicine is one of the oldest alternative medical systems which involves the use of therapeutics derived predominantly from plants, animals, minerals, diet, exercise, and lifestyle changes. Its therapies are centered on the principle of “Panchakarma,” which comprises five karmas (actions) to rejuvenate and remove toxins from one’s body [33].

    Study Selection and Data Collection Process

    Citations retrieved from the six databases were extracted into Endnote X9 software (Philadelphia, PA: Clarivate) and duplicated citations were removed. During the initial article screening, two independent reviewers (WY and SW) reviewed the titles and abstracts of articles to select relevant articles. Thereafter, the full texts of the identified articles were evaluated. All discrepancies during the article screening process were resolved by discussion with a third reviewer (JJ). Hand-searching of references within identified articles was also performed to enhance the comprehensiveness of the search. A standardized Microsoft Excel data collection form was used for data extraction, and details related to the study characteristics, studied indications of intervention, efficacy, and safety were collected.

    Management of Missing Data

    For studies with missing data, authors were contacted for clarification to enhance the comprehensiveness of this review. Missing information that could not be retrieved after two email reminders were labeled as unavailable.

    Risk of Bias in Individual Studies

    The Cochrane Risk of Bias tool version 2.0 (Oxford, England: Cochrane) was utilized in the assessment of the included RCTs [34]. Two independent reviewers (Teo and Chu) performed the risk of bias assessment (Appendix 2). The instrument comprises of the following five domains: risk of bias arising from the randomization process, deviations from intended interventions, missing outcome data, outcome measurement, and selection of reported results. Using the responses derived from the five domains, the overall risk of bias for the individual studies was rated as “low,” “some concerns,” or “high” risk of bias.

    Assessment of Heterogeneity

    Clinical and methodological heterogeneity of included studies were analyzed to evaluate if meta-analyses could be performed for specific interventions in this study. Clinical heterogeneity describes variation in characteristics of study participants, intervention, or outcomes while methodological heterogeneity describes variation in study design and risk of bias. This was performed by two independent reviewers (Yeam and Seng). In view of the clinical and methodological heterogeneity across the included studies, a narrative review of the RCTs was conducted.

    Synthesis of Data

    With regard to the efficacy of AMS interventions, the response rates and any changes in patients’ quality of life were recorded. Additionally, the safety profile of each intervention was evaluated and the reported prevalence, severity, and outcomes of adverse effects were tabulated. The adverse events reported in included studies were categorized using the Common Terminology Criteria for Adverse Events (CTCAE) [35].

    Summary Measures

    Descriptive statistics were utilized to summarize the characteristics of all included studies. The principal summary measures evaluated in this study were the studied indications, efficacy of each AMS, and safety profile of each AMS.

    Results

    Study Selection

    Out of 14,583 retrieved citations, 33 full-text articles were included in this review. The inclusion and exclusion criteria for the studies are shown in Figure 1. The percentage of agreement of articles between the reviewers was 94.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} and all disagreements were resolved after discussion.

    Role of Alternative Medical Systems in Adult Chronic Kidney Disease Patients: A Systematic Review of Literature
    Figure
    1:
    Flow chart for the inclusion of articles in this systematic review.

    Study Characteristics

    Types of AMS studied: Table 1 shows the characteristics of included studies. Among the four main types of AMS, TCM was the most studied (n=20, 60.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [3,7,17,36-52], followed by Ayurveda (n=6, 18.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [53-58], naturopathy (n=5, 15.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [59-63], and homeopathy (n=2, 6.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [16,64].

    Study (year of publication) Study design Number of patients in treatment and control arm Indication for use of intervention Treatment Comparator Country Patient population Mean age of patients (SD) Gender (male) ({fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c})
    Traditional Chinese medicine (n=20)
    Li et al. (2015) [41] Double-blinded parallel arm T1:66, C1:32, T2:56, C2:26 Renal function 8 g TSF granules and ARB BID x 24 weeks 8 g placebo TID and ARB BID x 24 weeks China Non-dialysis CKD patients T1:59.5 (10.1), C1:56.7 (9.3), T2:58.9 (9.0), C2:60.8 (10.0) T1:54.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C1:53.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, T2:58.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C2:53.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Ma et al. (2013) [43] Parallel arm T:25, C:20 Renal function 150 mL ZSTL solution BID x 3 months 10 mg benazepril QD x 3 months China Early DN patients T:57, C:57 T:40{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:40{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Wang et al. (2012) [17] Double-blinded parallel arm T1:192, T2:191, C:189 Renal function T1: TCM granules BID x 24 weeks, T2: TCM granules BID and 10mg benazepril QD x 24 weeks 10 mg benazepril QD and TCM placebo TID x 24 weeks China CKD stage 3 T1:47.3 (10.9), T2:49.3 (11.4), C:49.0 (10.5) T1:54.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, T2:47.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:47.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Yu et al. (2017) [50] Single-blinded parallel arm T:28, C:25 Renal function Acupuncture at Li4, ST36 and K13 acupoint QD x 3 months Sham acupuncture QD x 3 months China CKD stage 2-4 T:58.5, C:61.0 T:89.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:88.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Zhao et al. (2020) [52] Double-blinded parallel arm T:171, C:172 Renal function Herbal granules TID x 6 months Placebo granules x TID 6 months China CKD stage 3 T:51.89 (13.12), C:52.03 (12.62) T:62.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:70.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Xiang et al. (2016) [47] Parallel arm T:51, C:51 Renal function QDDHGa tablets BID x 12 weeks ARB tablets (minimum dosage) China DN patients T:57.21 (13.20), C:58.16 (11.59) T:24{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:22{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Xu et al. (2016) [49] Double-blinded parallel arm T:91, C:86 Renal function 500 mg GS-Rb1 (ginseng extract) QD x 6 months  Placebo tablets QD x 6 months China CKD stage 2-3 T:59.2 (8.5), C:58.4 (7.5) T:72.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:70.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Chen et al. (2013) [37] Parallel arm T:95, C:95 Proteinuria 9.6 g of Shenqi particle TID x 48 weeks Routine care China Non-dialysis CKD patients T:49 (14), C:53 (12) T:36.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:68.42{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Ge et al. (2013) [39] Parallel arm T:34, C:31 Proteinuria  40 mg TWHF TID x 3 months followed by 20 mg TWHF TID x 3 months 80 mg valsartan BID x 6 months China DN patients T:51.9 (9.8), C:51.0 (8.9) T:58.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:54.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Li et al. (2020) [42] Double-blinded parallel arm T:735, C:735 Proteinuria Huangkui capsule TID x 12 months Losartan potassium tablet QD and placebo capsules TIW x 12 months China CKD stage 1-3a T:37.7 (10.9), C:37.1 (10.4) T:48.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:46.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Zhang et al. (2014) [51] Parallel arm T1:133, T2:136, C:135 Proteinuria T1: Huangkui capsule TID x 6 months, T2: Huangkui capsule TID and Losartan potassium tablet QD x 6 months  Losartan tablet potassium QD x 6 months  China Non-dialysis CKD patients T1:37.3 (12.5), T2:37.1 (11.1), C:38.1 (12.7) T1:50.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, T2:47.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:53.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Xiong et al. (2020) [48] Parallel arm T:62, C:62 Proteinuria 60 mg TWHF and 160 mg valsartan QD x 24 weeks 160 valsartan QD x 24 weeks China Non-dialysis CKD patients T:50.3 (11.8), C:49.6 (12.3) T:69.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:72.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Che-Yi et al. (2005) [36] Double-blinded parallel arm T:20, C:20 Uremic pruritus Acupuncture at Quchi (L11) acupoint TIW x 1 month Sham acupuncture TIW x 1 month China ESRD T:62.4 (9.1), C:63.2 (7.5) T:45.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:50.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Gao et al. (2002) [38] Double-blinded parallel arm T:34, C:34 Uremic pruritus Acupuncture at Quchi (L11) and Zusanli (ST 36) acupoint BIW x 1 month Sham acupuncture BIW x 1 month China ESRD 43.6 59.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Nahidi et al. (2018) [7] Single-blinded parallel arm T:15, C:11 Uremic pruritus Acupuncture at various acupoints TIW x 6 weeks Sham acupuncture TIW x 6 weeks Iran HD T:54.7 (11.4), C:41.4 (16.2) T:60{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:73{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Ono et al. (2015) [3] Parallel arm T:23, C:17 Fatigue, insomnia, itchiness, and pain Acupuncture QIW x 2 months Routine care Japan HD T:70.0 (9.6), C:67.3 (13.0) NI
    Su et al. (2009) [44] Parallel arm T:31, C:30 QoL Infrared stimulation of Qihai (RN6), Kuamyuan (RN4) and Chungchi (RN3) TIW x 3 months Heat pad therapy to acupoints TIW x 3 months China ESRD T:61.07 (13.9), C:58.6 (12.6) T:51.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:56.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Wang et al. (2019) [45] Single-blinded parallel arm T:40, C:40 Wnt/β-catenin signaling pathway Qingshen granules TID x 3 months Placebo granules TID x 3 months China CKD stage 3-5 T:52.1 (10.4), C:54.9 (9.2) T:55{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:48{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Wang et al. (2020) [46] Parallel arm T:136, C:146 Immune function Qingshen granules TID x 3 months Routine care China CKD stage 3-5 T:54.0 (10.5), C:51.8 (12.0) T:55.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:57.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Li et al. (2009) [40] Parallel arm T:32, C:32 Vascular endothelial function TBN tablets (gingko extract) TI x 8 weeks Routine care China Early DN patients T:66.5 (71.1), C:67.2 (7.2) T:53.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Ayurveda (n=6)
    Alam et al. (2020) [53] Parallel arm T:70, C:66 Renal function Sativa oil QD and alpha-keto amino acid tablets TID x 3 months Alpha-keto amino acid tablets TID x 3 months India CKD stage 3-4 T:49.2, C:48.8 T:58.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:51.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Fallahzadeh et al. (2012) [54] Double-blinded parallel arm T:30, C:30 Renal function 140 mg silymarin tablet QD x 3 months Placebo tablet QD x 3 months Iran Non-dialysis CKD patients T:55.9 (8.3), C:57.6 (7.5) T:50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:43.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Hoseini et al. (2019) [55] Parallel arm T:22, C:22 Renal function Camel milk BID x 3 months Routine care Iran CKD stage 3-4 56.7 (11.8) 52.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Khajehdehi et al. (2011) [56] Double-blinded parallel arm T:28, C:28 Renal function 140 mg silymarin TID x 3 months Placebo tablet TID x 3 months Iran Non-dialysis CKD patients T:55.9 (8.3), C:57.6 (7.5) T:50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:43.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Makhlough et al. (2010) [57] Double-blinded parallel arm T:17, C:17 Uremic pruritus 0.03{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} capsaicin ointment QID x 4 weeks Placebo ointment QID x 4 weeks Iran ESRD 57 (18.6) 41.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Pingali et al. (2020) [58] Double-blinded parallel arm T1:18, T2:18, C:19 Hyperuricemia T1:500 mg of beleric capsule taken QD T2: 1000 mg of beleric capsule taken QD C:40 mg of febuxostat taken QD India CKD stage 2-3 T1:53.2 (8.9), T2:50.8 (8.8), C:51.0 (9.8) T1:72.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, T2:77.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:73.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Naturopathy (n=5)
    Khan et al. (2014) [60] Double-blinded parallel arm T:80, C:80 Malnutrition  Alpha-keto amino acid tablets TID x 3 months Placebo tablets TID x 3 months India Non-dialysis CKD patients T:45.0, C:45.0 T:59.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:57.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Prakash et al. (2004) [61] Double-blinded parallel arm T:21, C:19 Malnutrition  Keto amino acid tablets QD x 9 months Placebo tablets QD x 9 months India CKD stage 3-4 T:52.8 (14.1), C:55.9 (17.6) T:55.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:43.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Sedaghattalab et al. (2021) [62] Double-blinded parallel arm T:22, C:23 Inflammation Watercress extract QD x 1 month Placebo extract QD x 1 month Iran HD T:58.9 (16), C:63.1 (13) NI
    Zare et al. (2019) [63] Double-blinded parallel arm T:19, C:21 Inflammation Garlic extract tablets TIW x 2 months Placebo tablets TIW x 2 months Iran PD T:56.0 (16.1), C:52.8 (18.8) T:42.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:42.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Boldaji et al. (2019) [59] Crossover trial T:22, C:19 Hypertension, stress, and inflammation Pomegranate juice TIW x 2 months Routine care Iran ESRD 47.8 (13.3) 61{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Homeopathy (n=2)
    Cavalcanti et al. (2003) [16] Double-blinded parallel arm T:11, C:9 Uremic pruritus Homeopathic verum medicationb administered Placebo medication administered Brazil HD T:47, C:57 T:64{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:56{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Silveira et al. (2019) [64] Double-blinded parallel arm T:18, C:14 Renal function Brazilian green propolis pills BID x 3 months Placebo pills BID x 3 months Brazil CKD stage 1-5 T:52.8 (14.1), C:55.9 (17.6) T:55.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, C:43.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Table
    1: Characteristics of included AMS intervention studies.

    aQDDHG is composed of Huang Qi, Danshen, Dihuang, Shanyao, and Gan Cao.

    bDosage and frequency vary from patient to patient.

    ARB: angiotensin receptor blockers; DN: diabetic neuropathy; ESRD: end-stage renal disease; TBN: tianbaoning; TSF: tangshen formula; TWHF: Tripterygium wilfordii Hook F; ZSTL: zishentongluo; QoL: quality of life; QD: once a day; TIW: thrice a week; TID: thrice a day; CKD: chronic kidney disease; QIW: four times a week; HD: hemodialysis; T: test group; C: control group; T1: test group 1; T2: test group 2; C1: control group 1; C2: control group 2

    Overview of study design and patient characteristics in included studies are as follows: the majority of the studies were conducted in Asia (n=31, 93.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), whereas most of the studies were performed in China (n=18, 54.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}). Out of all reviewed studies, 20 (60.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) were blinded to randomized controlled trials. The sample size was greater than 50 patients in 21 (63.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) trials (Table 1). Non-dialysis patients were recruited in seven studies (21.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), whereas ESRD patients were recruited in five studies (15.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}). The average duration of follow-up for all studies was 4.9 months (Table 2).

    Study (year of publication) Indication for use of intervention Treatment (dose and duration if available) Comparator (dose and duration if available) Tool(s) used to assess outcomes Outcome Improvement symptoms (yes / no) Percentage reductiona/improvement in symptoms (if available) Follow-up duration
    Traditional Chinese medicine (n=20)
    Li et al. (2015) [41] Renal function 8 g TSF granules TID and ARB BID x 24 weeks 8 g placebo TID and ARB BID x 24 weeks WHOQOL-BREF, DQOL UAER (μg/min) (pre vs post): 105.39±77.29 vs 88.37±108.46, p=0.021 Yes -16.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (UAER) 6 months
    24 h urinary protein (g/24 h) (pre vs post): 1.12±0.75 vs 0.91±0.90, p=0.017 -18.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (24 h urinary protein)
    Ma et al. (2013) [43] Renal function 150 mL ZSTL solution BID x 3 months 10 mg benazepril QD x 3 months Radioimmunoassay, ELISA HbA1c ({fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) (baseline vs mean change from baseline): 10.68 (8.48, 13.96) vs -4.29 (-5.85, -2.79), p<0.05. Yes -40.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (HbA1c) 9 months
    UAER (μg/min) (baseline vs mean change from baseline): 211.52 (164.58, 243.89) vs -106.99 (-121.29, -85.55), p<0.05 -50.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (UAER)
    SCr (μmol/L) (baseline vs mean change from baseline): 87.17 (70.59, 110.25) vs -3.33 (-11.02, 2.15), p<0.05 -3.82{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (SCr)
    CCR (mL/min) (baseline vs mean change from baseline): 139.86 (129.58, 149.52) vs -9.22 (-13.42, -5.82), p <0.05 -6.59{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (CCR)
    Wang et al. (2012) [17] Renal function T1: TCM granuleb BID x 24 weeks. T2: TCM granuleb BID and 10 mg benazepril QD x 24 weeks. 10 mg benazepril QD and TCM placebo TID x 24 weeks MDRD study equation, TCM assessing sheets eGFR (mL/min/1.73 m2) (pre vs post): T1: 45.26±10.12 vs 48.46±15.90, p<0.05. T2: 44.68±9.82 vs 48.31±17.50, p<0.05. Yes 7.07{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (eGFR; T1), 8.12{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (eGFR; T2) 6 months
    24 h proteinuria (mg/24 h) (pre vs post): T1: 725.98 vs 990.00, p<0.05. T2: 590.00 vs 453.50, p<0.05 36.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (proteinuria; T1), -21.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (proteinuria; T2)
    Urinary albumin/creatinine (mg/gCr) (pre vs post): T2: 0.30 vs 0.22, p<0.05 -26.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (urinary albumin/creatinine; T2)
    Hb (g/L) (pre vs post): T1: 127.31±18.47 vs 129.57±21.82, p<0.05 17.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (Hb; T1)
    Yu et al. (2017) [50] Renal function Acupuncture at Li4, ST36 and K13 acupoint QD x 3 months Sham acupuncture QD x 3 months NI SCr levels (mg/dL) (T vs C): baseline: 1.45 vs 1.67, p=0.1298. Post-intervention: 1.41 vs 1.65, p=0.0489. 3-month follow-up: 1.32 vs 1.81, p=0.0467 Yes -2.76{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (SCr; pre vs post), -9.00{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (SCr; pre- vs 3 months follow-up) 6 months
    eGFR (mL/min/1.73m2) (T vs C): Baseline: 51.85 vs 42.50, p=0.0855. Post-intervention: 54.50 vs 43.60, p=0.0470. 3-month follow-up: 59.90 vs 40.80, p=0.0191 5.11{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (eGFR; pre vs post), 15.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (eGFR; pre-intervention vs 3 months follow-up)
    hs-CRP (mg/dL) (T vs C): Baseline: 1.10 vs 0.79, p=0.4361. Post-intervention: 0.80 vs 0.90, p=0.8773 -27.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (hs-CRP pre vs post)
    Zhao et al. (2020) [52] Renal function Herbal granulec TID x 6 months Placebo granules x TID 6 months Dye-binding method, Cerebrospinal fluid protein test kit, Determiner L CRE kit SCr (μmol/L) (pre vs weeks 16, 20 and 24): 148.42±35.90 vs 130.19±29.79, 130.08±30.57, 130.78±32.55, p<0.05 Yes -12.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (SCr; pre vs 16 weeks), -12.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (SCr; pre vs 20 weeks), -11.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (SCr; pre vs 24 weeks) 6 months
    Xiang et al. (2016) [47] Renal function QDDHG tablets BID and ARB (minimum dosage) x 12 weeks ARB tablets (minimum dosage) Guidelines for clinical research of Chinese medicine Albumin (mg/24h) (within treatment group, baseline vs 4 vs 8 vs 12 week): 85.30 (66.00, 176.30) vs 61.50 (49.00, 110.20), p<0.05 vs 51.00 (37.00, 90.00), p<0.05 vs 41.40 (29.00, 68.00), p<0.05 Yes -27.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (Albumin; 4 weeks), -40.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (Albumin; 8 weeks), -43.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (Albumin; 12 weeks) 3 months
    Proteinuria (g/24h) (within treatment group, baseline vs 4 vs 8 vs 12 week): 0.20 (0.10, 0.30) vs 0.10 (0.10, 0.20), p<0.05 vs 0.10 (0.10, 0.20), p<0.05 vs 0.10 (0.10, 0.20), p<0.05 -50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (Proteinuria; 4, 8, 12 weeks)
    Albumin/creatinine (mg/mol) (within treatment group, baseline vs 4 vs 8 vs 12 week): 20.70 (11.00, 30.50) vs 16.30 (8.10, 25.00), p<0.05 vs 15.00 (7.20, 20.60), p<0.05 vs 10.10 (5.60, 17.00), p<0.05 -21.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (albumin/creatinine; 4 weeks), -27.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (albumin/creatinine; 8 weeks), -51.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (albumin/creatinine; 12 weeks)
    Xu et al. (2016) [49] Renal function 500 mg GS-Rb1 (ginseng extract) QD x 6 months  Placebo tablets QD x 6 months ELISA Creatinine and urea level (T vs C): 6 months, p<0.01. 12 months, p<0.01 Yes – 12 months
    Oxidative stress markers (T vs C): 6 months, p<0.01. 12 months, p<0.05
    TNF-a level (T vs C): 6 months, p<0.05
    Chen et al. (2013) [37] Proteinuria 9.6 g of Shenqi particle TID x 48 weeks Routine care MDRD study equation Proteinuria (g/d) (pre vs post): 5.34±2.74 vs 2.04±2.15, p<0.001 Yes -61.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (proteinuria) 12 months
    eGFR (mL/min/1.73 m2) (pre vs post): 84.6±27.0 vs 100.7±37.5, p=0.001 19.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (eGFR)
    Ge et al. (2013) [39] Proteinuria 40 mg TwHF TID x 3 months, 20 mg TwHF TID x 3 months. 160 mg valsartan capsules QD x 6 months Trichloroacetic acid method, Jaffe reaction, MDRD study equation, high-performance liquid chromatography Urinary protein (g/24 h) (pre vs 1 month, pre vs 3 months, pre vs 6 months): 4.99±2.25 vs 3.23±2.57, p<0.01. 4.99±2.25 vs 2.83±1.57, p<0.01. 4.99±2.25 vs 2.99±1.81, p<0.01 Yes -35.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (urinary protein; 1 months), -43.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (urinary protein; 3 months), -40.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (urinary protein; 6 months) 6 months
    eGFR (mL/min/1.73 m2) (pre vs 6 months): 43.07±21.65 vs 38.71±23.66, p<0.05 -10.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (eGFR; 6 months)
    Li et al. (2020) [42] Proteinuria Huangkui capsule TID x 12 months Losartan potassium tablet QD and placebo capsules TIW x 12 months NI Proteinuria (mg/24 h) (pre vs post): 1238.9±667.4 vs 1008.8±1104.7, p<0.001 Yes -18.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (proteinuria) 12 months
    Zhang et al. (2014) [51] Proteinuria T1: Huangkui capsule TID x 6 months. T2: Huangkui capsule TID and Losartan potassium tablet QD x 6 months. Losartan tablet potassium QD x 6 months Biuret method, sarcosine oxidase assay Proteinuria within T1 (pre vs 12 vs 24 weeks): 1045±420 vs 762±533, p<0.001 vs 537±409, p<0.001 Yes T1: -27.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pre vs 12 weeks), -48.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pre vs 24 weeks) 6 months
    Proteinuria within T2 (pre vs 12 vs 24 weeks): 1073±439 vs 783±658, p<0.001 vs 529±509, p<0.001. T2: -27.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pre vs 12 weeks), -50.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pre vs 24 weeks).
    Xiong et al. (2020) [48] Proteinuria 60 mg TWHF and 160 mg valsartan QD x 24 weeks 160 valsartan QD x 24 weeks CKD-EPI equation Proteinuria (g/24 h) (T vs C, PP analysis): 3.16±0.62 vs 4.28±0.85, p<0.001 Yes PP: -26.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (proteinuria)  6 months
    Serum albumin (g/L) (T vs C, PP analysis): 37.65±4.31 vs 33.59±4.56, p<0.001 PP: 12.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (serum albumin)
    Proteinuria (g/24 h) (T vs C, ITT analysis): 3.36±0.83 vs 4.52±1.06; p<0.001 ITT: -25.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (proteinuria)
    Serum albumin (g/L) (T vs C, ITT analysis): 36.91±4.42 vs 34.67±4.75, p=0.008 ITT: 6.46{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (serum albumin)
    Che-yi et al. (2005) [36] Uremic pruritus Acupuncture at Quchi (L11) acupoint TIW x 1 month Sham acupuncture TIW x 1 month Validated questionnaire Pruritus scores (pre vs post vs 3 months follow-up): 38.2±4.8 vs 17.3±5.5 vs 16.5±4.9, p<0.001 Yes -54.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pruritus scores; pre- vs post-intervention), -56.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pruritus scores; pre-intervention vs 3 months follow-up) 3 months
    Gao et al. (2002) [38] Uremic pruritus Acupuncture at Quchi (L11) and Zusanli (ST 36) acupoint BIW x 1 month Sham acupuncture BIW x 1 month NI Number of patients (complete alleviation vs improvement vs no effect): 24 (70.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) vs 9 (26.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) vs 1 (2.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) Yes – 3 months
    Nahidi et al. (2018) [7] Uremic pruritus 30 minutes of acupuncture, for six weeks, at the following acupoints: Sp6, Sp10, Lv3, Li4, Li11. 30 minutes of sham acupuncture, for 6 weeks. VAS Pruritus scores (pre vs post): 9.87±0.35 vs 3.93±2.85, p<0.001 Yes -60.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pruritus scores) 6 weeks
    Ono et al. (2015) [3] Fatigue, insomnia, itchiness, and pain Acupuncture QIW x 2 months Routine care VAS, EQ-5D Headache score (pre vs post): 17.1±26.1 vs 6.2±13.5, p<0.05. Yes -63.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (headache score)  3 months
    Blurred vision score (pre vs post): 33.4±32.7 vs 17.0±22.2, p<0.05. -49.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (blurred vision score) 
    Dizziness score (pre vs post): 13.0±21.4 vs 1.4±6.3, p<0.05. -89.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (dizziness score) 
    Ear buzzing (pre vs post): 17.9±27.2 vs 8.0±14.7, p<0.05 -55.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (ear buzzing)
    Cervical pain (pre vs post): 37.7±39.1 vs 25.3±29.7, p<0.05 -32.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (cervical pain) 
    Stiff shoulders (pre vs post): 29.9±28.6 vs 12.5±21.6, p<0.05 -58.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (stiff shoulders) 
    Back pain (pre vs post): 38.5±33.7 vs 9.3±18.1, p<0.05 -58.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (back pain)
    Lower limb pain (pre vs post): 29.4±36.4 vs 17.1±23.3, p<0.05 -41.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (lower limb pain) 
    Numbness in upper limb (pre vs post): 18.9±30.4 vs 4.0±29.5, p<0.05 -78.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (numbness in upper limb) 
    Numbness in lower limb (pre vs post): 21.9±34.9 vs 11.0±26.2, p<0.05 -49.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (numbness in lower limb) 
    Itchiness (pre vs post): 38.7±40.7 vs 29.3±31.5, p<0.05 -24.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (itchiness)
    Difficulty in sleeping (pre vs post): 34.8±36.9 vs 12.8±22.5, p<0.05 -63.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (difficulty in sleeping)
    Utility in treatment group (pre vs post): 0.66±0.15 vs 0.76±0.17, p<0.05 15.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (utility)
    Su et al. (2009) [44] QoL Infrared stimulation of Qihai (RN6), Kuamyuan (RN4) and Chungchi (RN3) TIW x 3 months Heat pad therapy to acupoints TIW x 3 months Heart rate variability analyser, WHOQOL-BREF questionnaire LF activity (pre vs post): 49.99±79.08 vs 131.71±214.36, p=0.01 Yes 163{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (LF activity) 3 months
    Fatigue index (pre vs post): 133.90±20.43 vs 121.71±32.68, p=0.02 -9.10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (fatigue index)
    Psychological domain (pre vs post): 18.16±4.30 vs 19.39±0.72, p=0.02 6.77{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (psychological domain)
    Environmental domain (pre vs post): 29.87±4.04 vs 32.00±4.85, p=0.00. 7.13{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (environmental)
    Wang et al. (2019) [45] Wnt/β-catenin signaling pathway Qingshen granules TID x 3 months Placebo granules TID x 3 months ELISA Effective rates of TCM symptom (T vs C): 80{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} vs 60{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, p=0.024 Yes – 3 months
    eGFR (mL/min) (T vs C): 15.9±3.2 vs 14.0±4.0, p=0.019 17.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (eGFR)
    HIF-1𝛼 (ng/mL) (T vs C): 0.66±0.16 vs 1.39±0.17, p≤0.001 -61.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (HIF-1𝛼)
    Wnt1 (pg/mL) (T vs C): 314.2±85.8 vs 382.8±85.3, p=0.001 -16.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (Wnt1)
    𝛽-catenin (pg/mL) (T vs C): 416.5±13.6 vs 462.1±15.1, p ≤0.001 -10.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (𝛽-catenin)
    𝛼-SMA (KU/L) (T vs C): 20.5±3.1 vs 23.5±4.1, p≤0.001 -20.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (𝛼-SMA)
    E-cadherin (ng/mL) (T vs C): 2166.9±398.6 vs 2370.7±468.0, p=0.039 -15.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (E-cadherin)
    Wang et al. (2020) [46] Immune function Qingshen granules TID x 3 months Routine care Flow cytometry, ELISA CD4+/CD8+ T cell (pre vs post): 1.98±0.86 vs 1.58±0.72, p<0.05. Yes -20.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (CD4+/CD8+ T cell) 3 months
    Th17 cell (pre vs post): 2.51±1.05 vs 1.70±0.83, p<0.01. -32.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (Th17)
    NF-κB p65 (pre vs post): 36.84±12.96 vs 24.86±1.97, p<0.05 -32.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (NF-κB p65)
    IL-17 (pre vs post): 28.62±13.53 vs 19.78±12.25, p<0.05 -30.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (IL-17)
    IL-6 (pre vs post): 77.13±20.54 vs 58.42±18.25, p<0.05 -24.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (IL-6)
    TNF-α (pre vs post): 110.34±23.76 vs 75.49±22.80, p<0.01 -31.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (TNF-α)
    TRAF6 (pre vs post): 4.94±1.82 vs 2.85±1.53, p<0.01 -42.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (TRAF6)
    FN (pre vs post): 93.42±20.36 vs 62.86±19.35, p<0.01 -32.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (FN)
    Col-IV (pre vs post): 36.85±14.58 vs 24.36±13.36, p<0.01 -33.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (Col-IV)
    Total effective rate (T vs C): 79.41{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} vs 67.12{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, p<0.05. –
    Li et al. (2009) [40] Vascular endothelial function TBN tablets (gingko extract) TID x 8 weeks Routine care Chemical colorimeter, Radioimmunoassay, ELISA, Siemens Sequoia 512 color Doppler ultrasonography UAER (μg/min) (pre vs post): 153.30±63.28 vs 85.15±36.82, p<0.01 Yes -44.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (UAER) 3 months
    SCr (μmol/L) (pre vs post): 120.76±17.83 vs 105.67±18.13, p<0.01 -12.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (SCr)
    NO (μmol/L) (pre vs post): 50.16±24.64 vs 70.65±28.71, p<0.01 40.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (NO)
    vWF ({fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) (pre vs post): 182.05±64.13 vs 128.56±48.98, p<0.01 -29.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (vWF)
    BAID responsive change ({fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) (pre vs post): 4.91±2.31 vs 6.78±3.89, p<0.01 38.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (BAID responsive change)
    Ayurveda (n=6)
    Alam et al. (2020) [53] Renal function Sativa oil QD and alpha-keto amino acid tablets TID x 3 months Alpha-keto amino acid tablets TID x 3 months Hemogram, renal function test, serum electrolyte test Hb{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (g/dL) (pre vs post): 8.84±1.31 vs 10.24±1.10, p<0.001 Yes 15.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (Hb{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) 3 months
    24-h TUV (mL/day) (pre vs post): 1250.69±303.74 vs 1660.14±258.78, p<0.001 32.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (TUV)
    eGFR (mL/min) (pre vs post): 22.71±7.28 vs 42.42±17.38, p<0.001 86.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (eGFR)
    Fallahzadeh et al. (2012) [54] Renal function 140 mg silymarin tablet QD x 3 months Placebo tablet QD x 3 months Jaffé method, ELISA MDA assay, MDRD study equation, nephelometry, high-performance liquid chromatography, mercury sphygmomanometer Urinary TNF-α (pg/mg) (change from baseline): -3.45 (-5.44 to -1.46), p<0.05 Yes – 2 months
    Urinary MDA (nmol/mg) (change from baseline): -1.5 (-2.87 to -0.13, p<0.05
    Serum MDA (μmol/L) (change from baseline): -3.43 (-6.02 to -0.83), p<0.05
    Hoseini et al. (2019) [55] Renal function Camel milk BID x 3 months Routine care MDRD eGFR (pre vs post): 26.9±7.39 vs 31.45±8.99, p=0.001 Yes 16.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (eGFR) 3 months
    SCr levels (pre vs post): 2.58±0.71 vs 2.2±0.48, p=0.01 -14.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (SCr)
    BUN (pre vs post): 60.31±22.61 vs 44.38±14.29, p=0.0001 -26.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (BUN)
    Khajehdehi et al. (2011) [56] Renal function 140 mg silymarin TID x 3 months Placebo tablet TID x 3 months ELISA Proteinuria (mg/24h) (pre vs post, patients with type 2 diabetic nephropathy): 4328.7±3038.2 vs 2354.7±1800.1, p=0.001 Yes -45.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (proteinuria) 2 months
    IL-8 (pg/mL) (pre vs post, patients with type 2 diabetic nephropathy): 99.1±97.9 vs 43.6±55.0, p=0.002 -56.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (IL-8)
    TGF-β (pg/mL) (pre vs post, patients with overt type 2 diabetic nephropathy): 522.3±189.2 vs 397.3±55.2, p=0.006 -23.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (TGB-β)
    IL-8 (pg/mL) (pre vs post, patients with overt type 2 diabetic nephropathy): 41.4±50.3 vs 30.6±75.2, p=0.02 -26.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (IL-8)
    Makhlough et al. (2010) [57] Uremic pruritus 0.03{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} capsaicin ointment QID x 4 weeks Placebo ointment QID x 4 weeks Uremic pruritus scoring questionnaire by Duo Pruritus score (T vs C): 2.5±2.5 vs 7.2±5.5, p<0.05 Yes -84.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pruritus score)  
    Pingali et al. (2020) [58] Hyperuricemia T1:500 mg of beleric capsule taken QD. T2: 1000 mg of beleric capsule taken QD 40 mg of Febuxostat taken QD Jaffe method, MDRD Study equation, Salbutamol challenge test, Ellman’s method, Chrono-log light transmittance aggregometry, Spectrometry, Colorimetric detection with Griess reagents SCr (pre vs post): group B: 1.86±0.32 vs 1.64±0.29, p≤0.005. Group C: 2.06±0.26 vs 1.56±0.24, p≤0.0001 Yes -11.70{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}±9.00 (SCr, group B), -24.42{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}±8.14 (SCr, group C). 6 months
    eGFR (pre vs post): group B: 39.13±6.57 vs 45.96±11.14, p≤0.005. Group C: 34.78±5.34 vs 48.93±11.46, p≤0.0001 16.96{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}±14.87 (eGFR, group B), 40.39{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}±20.98 (eGFR, group C)
    Serum uric acid (pre vs post): Group B:8.10±0.67 vs 6.46±0.34, p≤0.0001. Group C: 8.54±0.64 vs 5.63±0.37, p≤0.0001 19.84{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}±6.43 (serum uric acid, group B), 33.88{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}±4.95 (serum uric acid, group C)
    Naturopathy (n=5)
    Khan et al. (2014) [60] Malnutrition Alpha-keto amino acid tablets TID x 3 months Placebo tablets TID x 3 months Blood tests Hb{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (g/dL) (T vs C): 9.39±0.87 vs 8.91±1.48, p<0.05 Yes 19.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (Hb{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) 3 months
    FBG (mg/dL) (T vs C): 104.00±8.46 vs 113.78±14.31, p<0.001 -20.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (FBG)
    Blood urea (mg/dL) (T vs C): 66.07±19.29 vs 79.78±24.79, p<0.001 -38.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (blood urea)
    SCr (mg/dL) (T vs C): 2.83±1.10 vs 3.33±1.37, p<0.05 -39.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (SCr)
    24 h TUP (g/day) (T vs C): 2.06±0.61 vs 2.43±0.97, p<0.01 -38.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (TUP)
    24 Hour TUV (mL/day) (T vs C): 1943.23±204.1 vs 1736.76±176.04, p<0.001 33.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (TUV)
    GFR (mL/min) (T vs C): 29.4±3.68 vs 23.3±1.63, p<0.001 49.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (GFR)
    Prakash et al. (2004) [61] Malnutrition Keto amino acid tablets QD x 9 months Placebo tablets QD x 9 months 99mTc-DTPA plasma sample method GFR (mL/min/ 1.73 m2) (pre vs post within C): 28.6±17.6 vs 22.5±15.9, p=0.015. Progress of renal failure prevented. – 9 months
    Serum total proteins (g{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) (pre vs post within C): 7.04±0.66 vs 6.56±0.83, p=0.038
    Mid-arm circumference (cm) (pre vs post within C): 28.0±4.4 vs 27.3±4.8, p=0.048
    Sedaghattalab et al. (2021) [62] Inflammation Watercress extract QD x 1 month Placebo extract QD x 1 month Blood tests, TBA reaction assay, Colorimetric kits, Spectrophotometer BUN (mg/dL) (pre vs post): 40.6±11.2 vs 34.6±15.1, p<0.04. Yes -14.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (BUN) 1 month
    Calcium (mg/dL) (pre vs post): 8.8±1.32 vs 10.4±2, p<0.001 18.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (calcium)
    Total oxidant status (μM) (pre vs post): 11.3±3.3 vs 6.9±2.4, p<0.001 -38.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (total oxidant status)
    Sulfhydryl protein (mmol/L) (pre vs post): 13.1±5.3 vs 7.4±4.3, p<0.001 -43.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (sulfhydryl protein)
    MDA (mmol/L) (pre vs post): 1.6±0.13 vs 0.42±0.27, p<0.001 -73.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (MDA)
    Superoxide dismutase (U/mL) (pre vs post): 29.3±6.3 vs 37.1±8.4, p<0.001 26.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (superoxide dismutase)
    Zare et al. (2019) [63] Inflammation Garlic extract tablets TIW x 2 months Placebo tablets TIW x 2 months Human homocysteine kits, ELISA IL-6 (pg/mL) (pre vs post): 2.2 (0.8, 6.4) vs 0.7 (0.6, 1.2), p<0.001 Yes -68.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (IL-6) 2 months
    CRP (mg/L) (pre vs post): 13.0 (5.0, 14.0) vs 2.0 (1.0, 9.0), p<0.001 -84.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (CRP)
    ESR (mm) (pre vs post): 50.7±28.5 vs 35.4±21.7, p=0.021. -30.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (ESR)
    Boldaji et al. (2019) [59] Hypertension, stress, and inflammation Pomegranate juice TIW x 2 months Routine care Mini nutritional assessment MDA (μmol L-1) (pre vs post): 0.88±0.01vs 0.77±0.01, p<0.001 Yes -12.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (MDA) 2 months
    Total antioxidant capacity (mmol L-1) (pre vs post): 0.40±0.08vs 0.49±0.11, p<0.001 22.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (total antioxidant capacity)
    IL-6 (ng L-1) (pre vs post): 3.00±1.48 vs 2.09±1.25, p<0.0001 -30.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (IL-6)
    Homeopathy (n=2)
    Cavalcanti et al. (2003) [16] Uremic pruritus Homeopathic verum medicationd administered Placebo medication administered Validated scale Pruritus score (pre vs 15 vs 30 vs 45 vs 60 days): 65±25 vs 46±29, p=0.002 vs 41±30, p=0.002 vs 42±29, p=0.002 vs 38±33, p=0.004 Yes -29.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pruritus score, pre vs 15 days), -36.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pruritus score, pre vs 30 days), -35.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pruritus score, pre vs 45 days), -41.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (pruritus score, pre vs 60 days) 60 days
    Silveira et al. (2019) [64] Renal function Brazilian green propolis pills BID x 3 months Placebo pills BID x 3 months Immunoturbidimetry, ELISA Proteinuria (mg/24 h) (T vs C, baseline vs 12 months): 695 (95{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} CI, 483 to 999) vs. 1403 (95{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} CI, 1031 to 1909); p=0.004 Yes -27.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} (proteinuria) 12 months
    Table
    2: Assessment of outcomes and efficacy of different AMS interventions.

    aPercentage reduction in symptoms is computed using (mean score at baseline – mean score post-treatment at end of study)/(mean score at baseline) for the treatment group.

    bTCM granules are formulated based on four TCM syndrome patterns (Qi Yin/Xue deficiency, blood stasis in the kidney, wind-dampness interfering in the kidney, and endoretention of damp heat) for the treatment of CKD.

    cHerbal granules consist of ten herbs: Huangqi, Danggui, Huzhang, Liuyuexue, Tufuling, Niuxi, Shiwei, Dahuang, Jixuecao, and Huangjing.

    dDosage and frequency vary from patient to patient.

    99mTc-DTPA: 99 m technetium diethylenetri-aminepenta-aceticacid; ARB: angiotensin II receptor blockers; BAID: brachial arterial inner diameter; BIW: twice a week; BUN: blood urea nitrogen; CCR: creatinine clearance rate; CKD-EPI: chronic kidney disease-epidemiology collaboration; DQOL: diabetes quality of life; eGFR: estimated glomerular filtration rate; ESR: erythrocyte sedimentation rate; ELISA: enzyme-linked immunosorbent assay; EQ-5D: EuroQol-5 dimension; FBG: fasting blood glucose; GS-RB1: Ginsenoside Rb1; HbA1c: haemoglobin A1c; ITT: intention to treat; LF: low frequency; MDA: malondialdehyde; MDRD: modification of diet in renal disease; NI: no information; PP: per protocol; QD: once a day; QDDHG: Qidan Dihuang Grain; SCr: serum creatinine; TBN: Tianbaoning; TCM: traditional Chinese medicine; TIW: thrice a week; TSF: Tangshen formula; TwHF: Tripterygium Wilfordii Hook F; TUP: total urine protein; TUV: total urine volume; UAER: urinary albumin excretion rate; VAS: visual analog scale; WHOQOL-BREF: World Health Organization Quality of Life-100 Questionnaire; ZSTL: Zishentongluo; Hs-CRP: high-sensitivity c-reactive protein; ITT: intention to treat; QIW: four times a week; HIF-1α: hypoxia-inducible factor 1-alpha; Wnt1: Wnt family member 1; α-SMA: alpha smooth muscle actin; TNF-α: tumor necrosis factor alpha; TRAF6: tumor necrosis factor receptor associated factor 6; FN: Fibronectin

    Tools used for outcomes assessments of symptoms during interventions are as follows: the most frequently utilized tools were the abbreviated version of the World Health Organization Quality of Life-100 Questionnaire (n=2) and visual analog scale (n=2).

    Risk of bias within studies: Out of all included studies, 14 (42.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) studies were assessed to be of “low” risk of bias, nine (27.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) and 10 (30.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) studies were scored as “some concerns” and “high” risk of bias, respectively.

    Results of Individual Studies

    Traditional Chinese medicine: The most commonly utilized interventions in the studies were herbal treatments (n=14, 70{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [17, 37-43, 45-49, 51, 52] followed by acupuncture (n=6, 30{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [3,7,36,38,44,50]. For acupuncture treatment, five studies used conventional acupuncture [3,7,36,38,50] while one study used infrared stimulation of acupoints [44]. The common acupoints administered during conventional acupuncture treatment were Li11 (n=3, 60{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), ST36 (n=2, 20{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), and Li4 (n=2, 20{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}). The frequency of acupuncture ranged from once a week to once a day, whereas the duration of studies lasted between six weeks to six months. Uremic pruritus (n=3, 60{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) was the most commonly studied indication, with reductions in pruritus score observed between 54.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} and 60.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} [7,36,38]. Infrared stimulation was used on RN6, RN4, and RN3 thrice a week for three months [44]. The indication studied was quality of life (QoL). According to QoL scores that were evaluated using the EQ-5D questionnaire, utility increased by 15.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}.

    Herbal treatments include six single-herb (n=6, 42.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [39-42,48,49,51] and eight multi-herbs formula granules (n=8, 57.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [17,37,41,43,45-47,52]. Common single-herb treatments used are Huangkui (n=2, 33.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) and TWHF (n=2, 33.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}). The frequency of treatment was once to three times a day, for two to 12 months. Proteinuria was the most studied indication (n=4, 66.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), where the various treatments reduced proteinuria between 27.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} and 61.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} [39,42,48,51]. Common herbs used in the multi-herb formula granules studies included Huang Qi (n=6, 75{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), Danggui (n=4, 50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), Salvia miltiorrhiza (n=3, 37.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), and Poria (n=3, 37.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}). The most commonly studied indication was improvement in renal function (n=5, 62.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [17,41,43,47,52]. Serum creatinine decreased (2.76-12.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) and eGFR increased (7.07-15.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) across the various treatments.

    Ayurveda: The included studies evaluated both plant-based (n=3, 50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [53,54,56] and animal-based (n=3, 50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) treatments [55,57,58]. The most common treatment studied was plant-based silymarin tablets (n=2, 33.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) while that for clinical indication was improvement in renal function (n=4, 66.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [53-56]. The eGFR increased between 16.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} and 86.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} across the various treatments [53-56].

    Naturopathy: Keto amino acids were the most studied naturopathic treatment (n=2, 40{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}). Common indications studied included anemia and glucose control, where hemoglobin and fasting blood glucose levels in subjects improved by 19.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} and 20.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, respectively [60,61]. The use of watercress and garlic extract was also studied for inflammation, where the total oxidant status and IL-6 levels were shown to improve by 38.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} and 68.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, respectively.

    Homeopathy: Homeopathic verum was studied for relief of uremic pruritus with improvement in pruritus score between 29.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} and 41.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} [16]. For Brazilian green propolis pills, it was studied for proteinuria where a 27.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} reduction in proteinuria was noted [64].

    Safety Profile of AMS Interventions

    The adverse events reported by all included studies are shown in Table 3. Adverse events reported were of grade 1 (n=13, 39.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), grade 2 (n=8, 24.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), and grade 3 (n=6, 18.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) severity. There were no life-threatening consequences or death related to adverse effects (grades 4 and 5) reported.

    Study (year) N (T) Treatment Reported adverse effects based on Common Terminology Criteria for Adverse Effects (CTCAE) v5.0a,b,c Onset of adverse effects (if available) Management and outcomes of patients
    Grade 1 ({fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) Grade 2 ({fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) Grade 3 ({fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c})
    Traditional Chinese medicine (n=19)
    Chenet al. (2013) [37] 95 9.6 g of Shenqi particle TID x 48 weeks NI Interstitial pneumonia (n=1, 1.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) Lung infection (n=5, 5.26{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); liver injury (n=3, 3.15{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NI NI
    Geet al. (2013) [39] 34 40 mg Tripterygium Wilfordii Hook F TID x 3 months Vomiting (n=13, 38.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) Hyperkalaemia (n=8, 23.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); Leukopenia (n=1, 2.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); Photosensitive dermatitis (n=3, 8.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NA NI Patient with decreased white blood cell withdrawn from the study
    Liet al. (2020) [42] 735 Huangkui capsule TID x 12 months NA NA Upper respiratory tract infections (n=21, 2.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NI NI
    Zhanget al. (2014) [51] T1:133 T2:136 T1: Huangkui capsule TID x 6 months T2: Huangkui capsule TID and Losartan potassium tablet QD x 6 months  Elevated cholesterol (T1: n=5, 3.76{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}; T2: n=4, 2.94{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) Upper respiratory tract infections (T1: n=4, 3.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}; T2: n=4, 2.94{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) Liver injury (T1: n=3, 2.26{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NI NI
    Xionget al. (2020) [48] 62 60 mg Tripterygium Wilfordii Hook F and 160 mg valsartan QD x 24 weeks Itchy skin (n=4, 6.45{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); nausea (n=3.22{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); rash (n=1, 1.61{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NA Liver dysfunction (n=12, 19.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); leukopenia (n=1, 1.61{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NI NI
    Liet al. (2015) [41] 122 8 g Tangshen Formula granules and angiotensin receptor blockers BID x 24 weeks NA Anaemia (n=2) Acute myocardial infarction (n=5) NI NI
    Maet al. (2013) [43] 25 150 mL zishentongluo solution BID x 3 months NA NA NA NA NA
    Wanget al. (2012) [17] T1:192 T2:191 T1: TCM granules BID x 24 weeks T2: TCM granules BID and 10 mg benazepril QD x 24 weeks Dry cough (T2: n=2, 1.04{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); Gastrointestinal symptoms (T1: n=7, 3.64{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}; T2: n=3, 1.57{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) Anaemia (T1: n=7, 3.64{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}; T2: n=6, 3.14{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) Liver injury (T1: n=2, 1.04{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}; T2: n=5, 2.61{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); hyperkalaemia (T1 n=7, 3.64{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}; T2 n=18, 9.42{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NI NI
    Yuet al. (2017) [50] 28 Acupuncture at Li4, ST36 and K13 acupoint QD x 3 months Mild pain, bleeding and bruising in some patients  NA NA NI Symptoms resolved spontaneously without any treatment
    Zhaoet al. (2020) [52] 171 Herbal granules TID x 6 months Mild abnormal liver function test (n=5, 2.92{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); Mild discomfort (n=2, 1.17{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NA   NI NI
    Xianget al. (2016) [47] 51 QDDHGb tablets BID x 12 weeks Insomnia (n=1, 1.96{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NA NA NI NI
    Xuet al. (2016) [49] 91 500 mg GS-Rb1 (ginseng extract) QD x 6 months  NA NA NA NI NI
    Che-yiet al. (2005) [36] 20 Acupuncture at Quchi (L11) acupoint TIW x 1 month Elbow soreness (n=2; 10.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NA NA NI Symptoms resolved spontaneously after 1 day.
    Gaoet al. (2002) [38] 34 Acupuncture at Quchi (L11) and Zusanli (ST 36) acupoint BIW x 1 month NA NA NA NA NA
    Nahidiet al. (2018) [7] 15 Acupuncture at various acupoints TIW x 6 weeks NA NA NA NA NA
    Onoet al. (2015) [3] 23 Acupuncture QIW x 2 months NA NA NA NA NA
    Suet al. (2009) [44] 31 Infrared stimulation of Qihai (RN6), Kuamyuan (RN4) and Chungchi (RN3) TIW x 3 months NA NA NA NA NA
    Wanget al. (2019) [45] 41 Qingshen granules TID x 3 months NA NA NA NA NA
    Wanget al. (2020) [46] 136 Qingshen granules TID x 3 months NA NA NA NA NA
    Liet al. (2009) [40] 32 Tianbaoning tablets (gingko extract) TID x 8 weeks NA NA NA NA NA
    Ayurveda (n=6)
    Alamet al. (2020) [53] 70 Sativa oil QD and alpha-keto amino acid tablets TID x 3 months NA NA NA NA NA
    Fallahzadehet al. (2012) [54] 30 140 mg silymarin tablet QD x 3 months Nausea and vomiting (n=3, 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); headache (n=2,6.67{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NA NA NI NI
    Hoseiniet al. (2019) [55] 22 Camel milk BID x 3 months NA Abdominal pain (n=1, 4.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NA NI NI
    Khajehdehiet al. (2011) [56] 28 140 mg silymarin TID x 3 months NA NA NA NA NA
    Makhlough et al. (2010) [57] 17 0.03{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} capsaicin ointment QID x 4 weeks NA Severe skin burning (n=1, 2.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NA NI NI
    Pingaliet al. (2020) [58] 18 1000 mg of beleric capsule taken QD Mild gastrointestinal intolerance (n=2, 11.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NA NA NA NA
    Naturopathy (n=5)
    Khanet al. (2014) [60] 80 Alpha-keto amino acid tablets TID x 3 months Nausea (n=5, 6.25{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); diarrhoea (n=5, 6.25{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NA NA NA NA
    Prakashet al. (2004) [61] 21 Keto amino acid tablets QD x 9 months NA NA NA NI NI
    Sedaghattalabet al. (2021) [62] 22 Watercress extract QD x 1 month NA NA NA NA NA
    Zareet al. (2019) [63] 19 Garlic extract tablets TIW x 2 months NA NA NA NI NI
    Boldajiet al. (2019) [59] 22 Pomegranate juice TIW x 2 months Stomach discomfort (n=1, 4.54{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) NA NA NI NI
    Homeopathy (n=2)
    Cavalcantiet al. (2003) [16] 11 Homeopathic verum medicationc administered NA NA NA NA NA
    Silveiraet al. (2019) [64] 18 Brazilian green propolis pills BID x 3 months NA NA NA NA NA
    Table
    3: Adverse effects reported with AMS usage.

    aThe adverse effects were graded based on Common Terminology Criteria for Adverse Effects (CTCAE).

    bQDDHG is composed of Huang Qi, Danshen, Dihuang, Shanyao, and Gan Cao.

    cDosage and frequency vary from patient to patient.

    Grade 1: mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2: moderate; minimal, local, or non-invasive intervention indicated; limiting age-appropriate instrumental activities of daily living. Grade 3: severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self-care activities of daily living. Grade 4: life-threatening consequences; urgent intervention indicated. Grade 5: death related to adverse effects; AE: adverse events; BID: twice a day; C: control arm; NA: not applicable; QD: once a day; T: treatment arm; TID: thrice a day; TIW: thrice a week

    Adverse effects associated with traditional Chinese medicine: the use of acupuncture is associated with mild pain, bleeding, bruising, and elbow soreness (grade 1) [36,40]. These symptoms resolved spontaneously without additional treatment. For single-herb treatments, TWHF treatment was associated with vomiting (38.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, grade 1), itchy skin (6.45{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, grade 1), nausea (3.22{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, grade 1), and rash (1.61{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, grade 1) [39,48]. Grade 2 adverse events associated with its use included hyperkalemia (23.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), leukopenia (2.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), and photosensitive dermatitis (8.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), while grade 3 adverse effects included liver dysfunction (19.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) and severe leukopenia (1.61{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}). Subjects who developed leukopenia were withdrawn from the study.

    For Huangkui treatment, adverse effects observed included elevated cholesterol (2.94-3.76{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) (grade 1), upper respiratory tract infection (2.94-3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) (grade 2 and grade 3), and liver injury (2.26{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) (grade 3) [42,51]. The use of Shenqi particles was associated with interstitial pneumonia (1.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, grade 2), lung infection (5.26{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, grade 3), and liver injury (3.15{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, grade 3) [37]. Anemia (grade 2) and acute myocardial infarction (grade 3) were observed for subjects using Tangshen formula granules [41]. The use of QDDHG tablets was associated with insomnia (1.96{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, grade 1) [47].

    Adverse effects associated with ayurveda: Silymarin treatment was associated with nausea and vomiting (10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), as well as headache (6.67{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [54,56]. Beleric capsule treatment was associated with mild gastrointestinal intolerance (11.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) [58]. Adverse effects from both studies were of grade 1 severity. Abdominal pain (4.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, grade 2) was observed with the treatment of camel milk [55].

    Adverse effects associated with naturopathy: All adverse effects reported for naturopathy treatments are of grade 1 severity (Table 3). They include nausea (6.25{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) and diarrhea (6.25{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) with the use of alpha-keto amino acid [60], as well as stomach discomfort (4.54{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) with the use of pomegranate juice [59].

    Adverse effects associated with homeopathy: No adverse effects were reported with the use of homeopathy (Table 3).

    Summary of Efficacy and Safety Profile of AMS Interventions

    Table 4 shows a summary related to the efficacy and safety profiles of AMS interventions.

    Type of AMS Common doses and treatment regimens and duration of therapy Indications Percentage reduction in CKD symptoms (if available) Adverse effects reported ({fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c})
    TCM (n=20) [3,7,17,36-52] Herbal Renal function 2.76{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 51.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} Elbow soreness (10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); liver injury and dysfunction (1.04-19.40{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); dry cough, pneumonia, and upper respiratory infections (1.04-5.26{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); hyperkalemia (3.64-23.50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); vomiting (38.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); leukopenia and anemia (1.61-2.90{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); photosensitive dermatitis, itchy skin, and rash (1.65-8.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); gastrointestinal symptoms, nausea, and vomiting (1.57-38.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); insomnia (1.96{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c})
    Herbal granules TID x 6 months; QDDHG tabletsa BID x 12 weeks; 500 mg GS-Rb1 QD x 6 months; 8 g TSF granules and ARB BID x 24 weeks; 150 mL ZSTL solution BID x 3 months; TCM granules BID x 24 weeks
    Acupuncture
    Acupuncture at Li4, ST36 and K13 acupoint QD x 3 months
    Herbal Proteinuria -61.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to -18.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    9.6 g of Shenqi particle TID x 48 weeks; 40 mg TWHF TID x 3 months followed by 20 mg TWHF TID x 3 months; Huangkui capsule TID x 12 months; 60 mg TWHF and 160 mg valsartan QD x 24 weeks
    Acupuncture Uremic pruritus -60.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to -54.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Acupuncture at Quchi (L11) acupoint TIW x 1 month; acupuncture at Quchi (L11) and Zusanli (ST 36) acupoint BIW x 1 month; acupuncture at various acupoints TIW x 6 weeks
    Acupuncture QIW x 2 months Fatigue, insomnia, itchiness, and pain -89.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 15.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Infrared stimulation of Qihai (RN6), Kuamyuan (RN4) and Chungchi (RN3) TIW x 3 months QoL -9.10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 163{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Qingshen granules TID x 3 months Wnt/β-catenin signaling pathway -61.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 17.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Qingshen granules TID x 3 months Immune function 42.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to -20.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    TBN tablets (gingko extract) TI x 8 weeks Vascular endothelial function 44.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 40.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Ayurveda (n=6) [53-58] Plant-based Renal function -56.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 86.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} Nausea, vomiting, and headache (6.67-10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); abdominal pain (4.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) severe skin burning (2.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c})
    Sativa oil QD and alpha-keto amino acid tablets TID; 140 mg silymarin TID x 3 months; 140 mg silymarin tablet QD x 3 months
    Animal-based
    Camel milk BID x 3 months
    0.03{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} capsaicin ointment QID x 4 weeks Uremic pruritus -84.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    1000/500 mg of beleric capsule taken QD Hyperuricemia -24.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 40.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Naturopathy (n=5) [59-63] Alpha-keto amino acid tablets TID x 3 months; Keto amino acid tablets QD x 9 months Malnutrition 39.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 49.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} Nausea (6.25{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); diarrhea (6.25{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}); stomach discomfort (4.45{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c})
    Watercress extract QD x 1 month; garlic extract tablets TIW x 2 months Inflammation -73.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 26.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Pomegranate juice TIW x 2 months Hypertension, stress, and inflammation -30.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 22.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Homeopathy (n=2) [16,64] Homeopathic verum medicationb administered x 60 days; Brazilian green propolis pills BD x 3 months Uremic pruritus -41.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to -29.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} –
    Renal function -27.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}
    Table
    4: Summary of efficacy and safety profile of AMS indicated for CKD symptoms.

    aQDDHG is composed of Huang Qi, Danshen, Dihuang, Shanyao, and Gan Cao.

    bDosage and frequency vary from patient to patient.

    Percentage reduction in symptoms is computed using (mean score at baseline – mean score post-treatment at end of study)/(mean score at baseline) for the treatment group.

    99mTc-DTPA: 99 m technetium diethylenetri-aminepenta-aceticacid, BAID: brachial arterial inner diameter, BID: twice a day, ELISA: enzyme-linked immunosorbent assay, GS-Rb1: Ginseng extract, MDRD: Modification of Diet in Renal Disease, QoL: Quality of life, TBN: Tianbaoning, TID: thrice a day, TIW: thrice a week, TwHF: Tripterygium Wilfordii Hook F, ZSTL: zishentongluo

    Discussion

    To the best of our knowledge, this is the first review that has summarized findings related to the therapeutic uses of AMS for CKD patients in RCTs. Among the four classes of AMS, TCM was the most studied class which has demonstrated efficacy in improving CKD-related symptoms and outcomes [3,7,36-52]. Among the TCM interventions evaluated, Huangkui, TWHF, and acupuncture have shown efficacy in reducing proteinuria and relieving uremic pruritus symptoms. The therapeutic basis of TCM for CKD is rooted in the restoration of vital energy and nourishment of blood, dispelling of heat and reduction of dampness, and regulation of Yin and Yang in the body [65]. In Western medicine, this is seen in a reduction in inflammation and oxidative stress, as well as boosting micro-circulation and enhancement of metabolism [52]. For example, Huangkui, also known as Abelmoschus manihot, reduces proteinuria by removing oxygen radicals, improving the circulation, and clearance of immune complexes as well as reducing inflammation and renal tubular epithelial injury [66]. It is also noted that triptolide, the key constituent of TWHF, suppresses the nuclear factor kappa b (NF-κB) signaling pathway and prevents the trigger of T lymphocytes and some inflammatory cytokines (TNF-α, IL-1β, IL-6, and IFN-γ), in addition to its podocyte-protective capabilities [67-70]. Notably, two of the included studies demonstrated that a combination of TCM and Western medicine, such as the intake of Huangkui capsule and losartan tablet to alleviate proteinuria, is more efficacious than taking TCM or Western medicine alone. This adds to existing evidence on potential applications of TCM alongside conventional medical therapy. Among patients on TWHF, regular checks of potassium and liver enzymes should be performed due to the risk of hyperkalemia and raised liver enzymes.

    With regards to the use of acupuncture, it results in the release of endogenous opiate-like substances that have been proposed to dull the peripheral and central perception of itching [71]. Stimulation of acupoints via far infrared (FIR) treatments has also been revealed to boost skin microcirculation, lessen emotional anxiety and promote excretion of waste products by improving the autonomic nervous system [44,72-76]. Enhanced circulation via a stronger autonomic nervous system is postulated to relieve CKD-related symptoms as the development of renal failure is attributed to poor circulation in the field of TCM [73,77]. Currently, renowned hospitals in the United States such as the Mayo Clinic and Duke University Medical Center have started providing acupuncture, along with other treatments. With growing evidence related to the efficacy and safety of TCM, there has been greater receptivity from medical doctors related to applications and use of TCM in clinical practice [78]. It is however important to note that TCM is not without any side effects. For example, the use of Huangkui should be cautioned in patients with hyperlipidemia or liver disease as its use has been associated with elevated lipid levels and liver injury. On the other hand, acupuncture appears to be relatively safe with mild side effects, such as elbow soreness. More studies related to TCM are required to further assess their long-term safety profile, and they should be prescribed with careful consideration of each patient’s health condition.

    For Ayurveda, silymarin was one of the most studied interventions which demonstrated efficacy in improving renal function. Ayurvedic therapies are derived predominantly from plants, animals, minerals, exercise, and lifestyle changes. They are believed to rejuvenate and remove toxins from one’s body. In conventional medicine, the therapeutic effects of ayurveda for CKD are ascribed to their anti-inflammatory and anti-oxidant properties. For instance, silymarin has shown efficacy in in vitro studies in attenuating inflammatory stress in renal tissue by suppressing the NF-κB signaling pathway and hence TNF production [79-85]. Other Ayurvedic treatments, such as the application of capsaicin ointment, were also found to alleviate uremic pruritus. Topical capsaicin, a natural alkaloid derived from red chili pepper, has been discovered to relieve uremic pruritus by binding specifically to type C sensory neurons and resulting in the release of substance P, as well as suppressing its synthesis, transport, and storage thereafter [57]. Relatively few side effects were observed for the Ayurvedic therapies discussed above. Despite the promising benefits associated with Ayurvedic treatments, it is currently less globally recognized as compared to TCM [86]. Further research is necessary to evaluate their efficacy and safety profile to improve their acceptance in clinical practice as adjunctive treatments, in particular for CKD patients.

    For naturopathy, its unique attribute lies in the reprioritization of the order of therapeutics, with increased emphasis on non-invasive treatments, such as lifestyle modifications and nutrition, over medical or surgical interventions. In this review, one of the more studied interventions is the use of ketoanalogues of essential amino acids (KAs). The addition of KAs to a low-protein diet has been shown to improve renal function and uremia. Notably, while lowering protein intake may improve renal function in CKD patients by altering immunologic events and reducing hypertrophy and hyperfiltration in the remaining nephrons, it may result in malnutrition [87-89]. However, the supplementation of KAs not only averts malnutrition by ensuring adequate consumption of amino acids but also alleviates uremia [61]. The absence of amino nitrogen in KAs allows them to become transaminated by taking nitrogen from non-essential amino acids and hence, reducing the production of urea via re-using the amino group [90,91]. Relatively few and mild adverse effects were observed for the included naturopathic therapies, rendering them attractive treatment options. Additionally, as naturopathic treatments are usually non-invasive, they can be easily combined with conventional medications. Of note, 28 health systems, hospitals, and cancer treatment centers in the United States currently have at least one licensed naturopathic physician at their premises [92]. With increasing research evaluating the efficacy and safety profile of naturopathic treatments, its role as potential adjunctive treatment for CKD patients is also likely to expand in the future.

    Lastly, homeopathy has also shown efficacy in improving CKD-related symptoms and outcomes. Homeopathy entails the therapeutic administration of substances derived from plants, minerals, or animals which produce effects that correspond to the clinical manifestation of diseases. In this review, the use of Brazilian green propolis pills and homeopathic verum medication were found to improve renal function and alleviate uremic pruritus, respectively. Brazilian green propolis was reported to improve renal function via a few mechanisms. Firstly, it decreases proteinuria via its ability to reduce urinary oxidative stress and macrophage infiltration into the kidneys [93]. Secondly, chrysin, a flavonoid in propolis has been shown to decrease podocyte apoptosis in patients with diabetic nephropathy and lessen glomerular injury [94]. Lastly, propolis has also been shown to decrease blood pressure via acetylcholine-induced vasodilation and from its antioxidant properties [93,95-97]. With regard to the safety of homeopathic treatment, no adverse effects were reported across included studies. However, the practice of homeopathy is relatively restricted, with 36{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of states in the United States requiring homeopathic practitioners to either be licensed Western medicine or Naturopathic practitioners [32]. Consequently, more research is necessitated to validate the efficacy and safety of homeopathic treatment as adjunctive therapy for CKD patients.

    Limitations

    The following limitations should be considered in conjunction with this review. Firstly, due to the clinical and methodological heterogeneity of the studies, meta-analyses were not performed. As the pool of evidence for AMS trials for CKD patients grows, subsequent reviews should consider conducting meta-analyses for the efficacy of AMS treatments for CKD patients. In addition, there could have been exclusion of potentially applicable studies even though an extensive search strategy was used. To prevent this, the references of included studies were also hand-searched as part of our search strategy. Another limitation of the study relates to the inclusion of only articles in English language. Researchers should consider the inclusion of studies in other languages such as Chinese and Tamil in future reviews. Finally, although results of the included studies were reported normalized Z scores, care should be taken when interpreting these values and comparing the efficacy of various AMS classes. This is due to considerable diversity in types of outcomes evaluated and comparator arms and tools adopted for evaluation of outcomes. Overall, it is hoped that with greater standardization of study outcomes for AMS therapies in future studies, these normalized Z scores can enable more purposeful comparisons of the efficacy of the different AMS classes.

  • Brazilian Federal Council of Medicine Bans CBD Prescriptions for Adult Patients

    Brazilian Federal Council of Medicine Bans CBD Prescriptions for Adult Patients

    The Brazilian Federal Council of Medication (CFM in the Portuguese acronym) is after all over again stepping above the profession’s ethics code and ignoring the newest advancements in healthcare science to impose an ideological ban to limit the prescription of CBD for grownup clients. The new conclusion, regretably, will come as no surprise as the CFM experienced by now stained its status throughout the coronavirus disaster by currently being sued for collective damages by the Brazilian Public Defender’s Office for letting physicians to prescribe hydroxychloroquine for “early treatment” of COVID-19, an unfounded procedure that was publicly supported by Bolsonaro and his then-presidential mate Donald Trump.

    The cannabis conclusion was published in the Brazilian Federal Sign up on October 11, to be carried out quickly and only to be revised in three several years. It policies that the “prescription of cannabidiol (CBD) is authorised as healthcare therapy” only “for the procedure of epilepsy in childhood and adolescence refractory to regular therapies in Dravet and Lennox-Gastaut Syndrome and Tuberous Sclerosis Complex”. Its prescription for any other conditions has consequently been banned. Medical professionals are further prohibited from offering lectures and classes on the use of cannabidiol and/or solutions derived from Hashish exterior of a scientific atmosphere.

    CFM’s decision arrives in the context of at the same time growing need for CBD products and solutions, and ideal-wing propaganda versus the legitimate professional medical rewards of cannabis. In between 2017 and 2021, the quantity of personal requests to import health-related hashish jumped from 2,101 to 32,416, a 1,442{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} raise. The growth in the demand for healthcare hashish has even triggered some of Bolsonaro’s cupboard ministers to issue publications denying that hashish is variety of medication. 

     

    CBD oil is not cost-effective to the vast majority of Brazilian patients. The value of a 20mg/ml bottle in a popular chemist fees one-fourth of the minimal wage. A 200/mg bottle costs additional than two minimal wages. A lot of clients and their households count on medical hashish associations to get their medicine for a much more reasonably priced selling price. Supply: Drogaria Sao Paulo  

     

    While the professional medical hashish invoice is stalled in the Brazilian Congress with no currently being forwarded to the Senate for ultimate approval, and with Brazilian significant Pharma controlling what handful of goods are authorized on the restricted Brazilian professional medical cannabis marketplace, the CFM is offering a message to culture: thoughts and ideology are what guideline wellness policy, and science can be discredited with the stroke of a pen.

    If the intention of the greatest authority dependable for supervising and regulating health-related exercise in Brazil is to divert patients to the illegal market place, then their mission will surely be prosperous. We know what occurs when substances become prohibited and inaccessible via authorized strategies: persons vacation resort to the illegal market. There are some individuals who are committed to supplying people with cannabis oil in Brazil, irrespective of its authorized standing, participating in civil disobedience to assure that persons can stil access their drugs. The issue, even though, is that these perfectly-intentioned citizens expose themselves to criminal punishment, and are also only in a position to offer entire-spectrum oil, which may well not satisfy the requirements of numerous patients. What we are witnessing below is, again, the criminalisation of lifetime-restoring and everyday living-preserving drugs, a drugs that has the ability to restore the life not only of individuals who use it but also of household customers who care for them. 

    The CBD ban is even further worrying news for the long term of Brazilian drug coverage, in particular supplied the the latest pattern of common cannabis campaigners picking out to abandon their political stances on drug rules to cater to conservative constituents. With the election of the most significantly-ideal Congress considering the fact that the re-democratisation of Brazil at the stop of its navy dictatorship in 1985, attempts for building and employing a more humane drug coverage will be an uphill fight, even if Lula wins in opposition to Bolsonaro in the 2nd round which will get put on the 30th of Oct. Meanwhile, civil society is organising alone, demanding prolonged overdue improvements, with constituents correctly voting in at minimum a few professional-cannabis lawmakers into office environment at the state and federal stage. 

    On Monday the 17th of October, a short while ago re-elected congressman Paulo Teixeira (of Lula’s Personnel Celebration), who chaired the exclusive commission that voted on the professional medical cannabis monthly bill, submitted a legislative decree to revoke CFM’s new choice. It is now very important that the even now-tiny hashish caucus stress Bolsonaro’s ally and President of the Chamber of Deputies, Arthur Lira, to unblock the health care hashish bill frozen in Congress. It is time for Brazilian institutions to work for the persons all over again, rather of serving the ideological agenda of the present president and his goons.

  • Research finds less than 7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the U.S. adult population with good cardiometabolic health

    Research finds less than 7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the U.S. adult population with good cardiometabolic health

    A lot less than 7 p.c of the U.S. grownup inhabitants has very good cardiometabolic well being, a devastating wellness disaster demanding urgent motion, according to analysis led by a workforce from the Friedman School of Diet Science and Policy at Tufts College in a revolutionary point of view on cardiometabolic health tendencies and disparities released in the July 12 concern of the Journal of the American Higher education of Cardiology. Their workforce also included researchers from Tufts Professional medical Heart.

    Scientists evaluated Individuals throughout five parts of well being: concentrations of blood stress, blood sugar, blood cholesterol, adiposity (over weight and weight problems), and presence or absence of cardiovascular disease (coronary heart assault, stroke, and so on.). They located that only 6.8 p.c of U.S. grown ups had ideal levels of all five parts as of 2017-2018. Between these 5 elements, trends amongst 1999 and 2018 also worsened significantly for adiposity and blood glucose. In 1999, 1 out of 3 grownups experienced optimum degrees for adiposity (no over weight or weight problems) that variety lowered to 1 out of 4 by 2018. Furthermore, whilst 3 out of 5 grownups didn’t have diabetic issues or prediabetes in 1999, much less than 4 out of 10 grownups have been absolutely free of these disorders in 2018.

    &#13

    These quantities are putting. It is deeply problematic that in the United States, one particular of the wealthiest nations in the globe, much less than 1 in 15 grownups have optimum cardiometabolic health. We will need a entire overhaul of our health care program, food program, and crafted natural environment since this is a disaster for anyone, not just a person segment of the population.”

    &#13
    &#13

    Meghan O’Hearn, doctoral candidate, Friedman Faculty and study’s guide writer

    &#13

    The study seemed at a nationally representative sample of about 55,000 people today aged 20 several years or older from 1999 to 2018 from the 10 most latest cycles of the Countrywide Wellbeing and Nourishment Evaluation Survey. The research staff focused on optimum, intermediate, and very poor amounts of cardiometabolic health and its parts, somewhat than just presence or absence of illness. “We have to have to change the conversation, mainly because disease is not the only problem,” O’Hearn stated. “We will not just want to be absolutely free of ailment. We want to attain ideal wellness and very well-currently being.”

    The researchers also determined huge health disparities concerning people of distinct sexes, ages, races and ethnicities, and education stages. For example, adults with fewer education have been 50 {fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} as probable to have exceptional cardiometabolic health when compared with older people with more education, and Mexican Americans experienced a person-3rd the exceptional degrees vs . non-Hispanic White adults. Furthermore, between 1999 and 2018, when the share of grown ups with fantastic cardiometabolic health modestly increased among the non-Hispanic White Americans, it went down for Mexican American, other Hispanic, non-Hispanic Black, and older people of other races.

    “This is actually problematic. Social determinants of health these types of as foods and nutrition security, social and local community context, financial security, and structural racism place people today of distinct education and learning ranges, races, and ethnicities at an enhanced threat of overall health troubles,” explained Dariush Mozaffarian, dean of the Friedman School and senior author. “This highlights the other critical get the job done going on throughout the Friedman School and Tufts College to much better fully grasp and deal with the underlying leads to of lousy nourishment and health disparities in the U.S. and about the environment.”

    The research also assessed “intermediate” amounts of overall health-not best but not nevertheless weak-like situations like pre-diabetes, pre-hypertension, and chubby. “A substantial part of the inhabitants is at a vital inflection point,” O’Hearn mentioned. “Figuring out these persons and addressing their wellness problems and way of living early is important to lowering expanding health care burdens and overall health inequities.”

    The repercussions of the dire point out of well being amid U.S. grownups arrive at beyond personalized overall health. “Its impacts on national health care shelling out and the monetary health of the total financial system are tremendous,” O’Hearn said. “And these disorders are mainly preventable. We have the community health and medical interventions and procedures to be in a position to deal with these complications.”

    Scientists at the Friedman College do the job actively on many these kinds of answers, O’Hearn mentioned, including Food items is Medication interventions (utilizing fantastic nutrition to support stop and treat health issues) incentives and subsidies to make healthful food stuff much more economical customer schooling on a nutritious eating plan and non-public sector engagement to generate a healthier and much more equitable food items technique. “There are a lot of unique avenues via which this can be accomplished,” O’Hearn stated. “We require a multi-sectoral technique, and we will need the political will and want to do it.”

    “This is a overall health disaster we’ve been experiencing for a even though,” O’Hearn reported. “Now there is a rising economic, social and moral very important to give this issue drastically extra attention than it has been receiving.”

    Source:

    Journal reference:

    O’Hearn, M., et al. (2022) Traits and Disparities in Cardiometabolic Wellness Among U.S. Adults, 1999-2018. Journal of the American College or university of Cardiology. doi.org/10.1016/j.jacc.2022.04.046.

  • The connection between adult ADHD and nicotine

    The connection between adult ADHD and nicotine

    Grown ups with interest deficit hyperactivity ailment (ADHD) are additional likely to smoke cigarettes and turn out to be dependent on nicotine. They may well also obtain it extra tough to give up smoking cigarettes nicotine. Scientists are investigating why this is the circumstance.

    According to Little ones and Adults with Interest-Deficit/Hyperactivity Problem (CHADD), as many as 10 million older people in the United States (U.S.) have ADHD.

    Nicotine is a normal ingredient of tobacco. The Meals and Drug Administration (Food and drug administration) clarifies that nicotine can improve how the brain works, major to cravings and addiction.

    Tobacco goods, these types of as cigarettes, provide nicotine to the mind promptly. This satisfies a person’s cravings for nicotine. However, it also would make it a lot easier for a human being to come to be dependent on it and makes it more challenging to give up smoking cigarettes.

    Cigarette smoking nicotine can increase a person’s chance of building heart ailment, stroke, lung cancer, and other health ailments.

    This report explores the relationship involving ADHD and cigarette smoking nicotine.

    ADHD is a neurodevelopmental condition that can have an effect on small children and grown ups. According to the Facilities for Sickness Control and Avoidance (CDC), folks with ADHD show a pattern of inattentive and hyperactive signs or symptoms.

    Some of the signs or symptoms of ADHD, according to the CDC, incorporate:

    Folks with ADHD might display screen either inattentive or hyperactive signs or symptoms, but commonly, folks with ADHD display both of those.

    A health care experienced can diagnose an adult with ADHD if they expertise five or more of these symptoms, and the indicators have been present for at least 6 months.

    The signs and symptoms also have to be present in two or extra options — this sort of as at household and at function — and they should negatively effects a person’s operating and overall performance.

    Understand additional

    Discover far more about diagnosing ADHD.

    People with ADHD are far more most likely to start out cigarette smoking nicotine cigarettes than people with out ADHD. They could also have a lot more intense withdrawal symptoms when they stop cigarette smoking.

    A 2016 analyze as opposed the cigarette smoking behaviors of young adults and uncovered that these with ADHD had been noticeably extra probable to turn out to be each day smokers than people without the need of ADHD.

    The researchers also be aware that immediately after the participants stopped smoking, those with ADHD reported much more rigorous withdrawal symptoms and much better cravings than people without the need of ADHD.

    Traits in cigarette using tobacco between adults in the U.S. are dropping, according to the CDC. Having said that, this pattern is not mirrored between folks with ADHD, suggesting that ADHD is a hazard element for smoking cigarettes.

    Estimates from CHADD also recommend that, as properly as obtaining larger smoking premiums, youth with ADHD are twice as very likely to turn into addicted to nicotine than their friends with out ADHD.

    Find out much more about the connection among ADHD and compound misuse.

    Why is nicotine use better in people with ADHD?

    One clarification could be that some individuals with ADHD come across that nicotine can help them regulate their symptoms.

    Nicotine’s stimulating outcomes could support increase consideration and focus in men and women with ADHD. This concept is identified as the self-medication theory, according to 2015 investigate.

    Nevertheless, a 2017 assessment signifies that acquiring early remedy with recommended ADHD medication does not avoid nicotine use.

    ADHD and cigarette smoking

    People today with ADHD have a tendency to have far more problems quitting smoking cigarettes than folks without having ADHD. Far more investigate is necessary to come across out why, but a 2018 assessment shows that people today with ADHD are far more inclined to earning impulsive conclusions and frequently favor a more compact rapid reward over a larger reward in the long run.

    Persons with ADHD may be a lot more likely to find the rapid correct of nicotine that smoking offers simply because it is a behavior that provides an immediate reward.

    Nevertheless, extra research is essential to totally comprehend why smoking cigarettes charges are increased in people with ADHD and why they uncover it harder to quit cigarette smoking.

    In accordance to the CDC, medical doctors normally prescribe stimulants to help people today with ADHD manage their signs or symptoms. Nicotine stimulates the mind in identical strategies and can enable a individual aim on a process and boost concentration degrees.

    A 2016 examine suggests that nicotine has beneficial outcomes on the focus, awareness, and emotional regulation of people with ADHD.

    Even so, the results are limited-lived. Over time, several people need to have to smoke more nicotine far more normally to accomplish the identical outcomes.

    Also, men and women with ADHD obtain it harder to stop smoking cigarettes nicotine and might sense far more extreme withdrawal signs or symptoms when they do.

    In accordance to the CDC, cigarette smoking cigarettes is the primary bring about of preventable fatalities in the U.S.

    People who smoke are more likely to create wellness ailments such as heart ailment, stroke, and lung cancer than folks who do not smoke.

    Aside from the normal dangers of smoking cigarettes nicotine, exploration suggests that youthful people today with ADHD who smoke are a lot more very likely to misuse other substances, such as liquor and other medicines.

    The explanations for this are not but known, and further more analysis is needed to clarify the backlink.

    Locate out why cigarette smoking is lousy for your overall health.

    This area answers some usually asked questions about ADHD and nicotine.

    Can nicotine affect ADHD medicine?

    Nicotine is a stimulant that functions on the mind in a similar way to some of the drugs made use of to deal with ADHD.

    Whilst most of the investigation into ADHD has targeted on children, there is no evidence to recommend that nicotine interferes with any ADHD drugs.

    Can quitting nicotine impact ADHD?

    The health implications of cigarette smoking nicotine are the similar for persons with or devoid of ADHD. Nevertheless, a 2016 analyze suggests that people today with ADHD may feel the withdrawal indicators more strongly than those people without ADHD.

    Quite a few of the signs or symptoms of nicotine withdrawal are prevalent qualities among individuals with ADHD. These symptoms can include:

    According to a 2017 evaluate, some men and women with ADHD feel the severity of these signs and symptoms raises during nicotine withdrawal.

    A individual with ADHD must carry on to acquire any recommended medicines when quitting the use of nicotine. This might aid cut down the severity of withdrawal symptoms.

    Uncover out what occurs to your physique when you stop smoking.

    Smoking nicotine will increase the danger of:

    • cancer
    • heart ailment
    • stroke
    • diabetes
    • and a lot more

    The CDC claims quitting cigarette smoking is one particular of the most essential methods a individual can just take to enhance their overall health and excellent of existence.

    A person with ADHD could come across it more durable to stop cigarette smoking nicotine, but there are ways to aid. Some valuable strategies contain:

    • Behavioral therapies and counseling: Folks with ADHD who are making an attempt to give up cigarette smoking may possibly discover behavioral therapies, these as cognitive behavioral therapy (CBT), useful. Remedy might present coping approaches to enable people resist cravings.
    • Making use of incentives: A particular person with ADHD could find it valuable to use reward-based practices when making an attempt to quit cigarette smoking. An older 2010 literature overview identified that monetary incentives could assistance folks with ADHD halt smoking. A human being could replicate this by allowing for themselves to have a take care of just about every 10 times of not cigarette smoking, or by employing an app that rewards a person for very good habits.
    • Using nicotine replacements: Merchandise such as nicotine patches or gum may possibly also help lower any cravings or withdrawal signs for these who are struggling to stop.
    • Utilizing substitute medicine: Whilst there is constrained evidence to help the effectiveness, some individuals use complementary medicines, these as hypnotherapy and acupuncture, to quit cigarette smoking.

    Some people today may well uncover that it can take quite a few tries to quit smoking cigarettes. This does not suggest that a man or woman has unsuccessful at quitting. Each try can display a man or woman which strategies are most handy for them.

    Any individual with ADHD who is seeking to quit cigarette smoking nicotine ought to discuss with a health care professional about receiving aid.

    In this article are 11 useful suggestions for supplying up cigarette smoking.

    In 2019, the U.S. federal government lifted the legal age at which somebody can obtain tobacco to 21. This features the sale of e-cigarettes. The hope is that this will deter more youthful men and women from starting off to smoke nicotine.

    Ideally, a individual with ADHD will have obtain to medicine, counseling, behavioral therapies, and instructional support to help them cope with the problem and stay clear of behaviors these kinds of as using tobacco nicotine.

    Proper medicine will clear away the have to have to self-medicate. Even so, attributes of the disorder, such as impulsiveness, risk-using, and searching for immediate rewards, might even now lead a human being to nicotine cigarettes.

    The before a man or woman stops smoking nicotine, the less difficult it is and the more rapidly they see the overall health gains.

    Find out far more about drugs for ADHD.

    Persons with ADHD are more very likely to smoke nicotine and have a more difficult time quitting than folks with out ADHD. They may possibly also encounter stronger withdrawal indications and cravings.

    Grown ups with ADHD who use nicotine cigarettes to assist take care of their signs may possibly come across that with appropriate treatment, they can stop.

    Human being-specific behavioral therapies and counseling can also support men and women cope with any cravings involved with nicotine withdrawal.

  • Health Tips Tuesday: adult depression

    Health Tips Tuesday: adult depression

    (WGGB/WSHM) – Country tunes singer Naomi Judd’s new dying has introduced to the forefront the issue of mental wellbeing and despair and how it is impacting grown ups.

    Dr. Stuart Anfang, chief of adult psychology at Baystate Well being, spoke with us about the signals to glance out for and productive treatment plans.

    What are the indicators to seem out for in grownups suffering from depression?

    Anfang: “So we glance for what we simply call the neurovegetative signs of melancholy that easily includes slumber disturbance, urge for food disturbance, lessened power, lowered interest in matters, sometimes feelings to harm you or suicidal feelings…All those are amongst the signals that we glimpse for to diagnose despair. Of training course, we want to rule out other things and health-related problems or other psychiatric health problems that could have some of the identical signs or symptoms.”

    The Countrywide Institute of Mental Health reviews that an estimated 21 million grownups experienced at minimum a single deprsssive episode. That amount signifies 8.4 {fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of all adults in the U.S. Is adult melancholy escalating?

    Anfang: “So what I would say is that definitely or awareness of despair and variety of the manifestations of melancholy have escalated unquestionably more than the very last two years. In the course of COVID, I consider that the isolation, the disruption induced by COVID, absolutely now the financial stressers, and other form of world wide stressers all have enhanced peoples symptom mentology and also in all probability improved peoples recognition of and with any luck , motivation to get some aid, so over-all we are in all probability seeing an icrease in at least persons trying to get out aid.”

    What are the most helpful solutions for despair?

    Anfang: “So despair signs exsist on the spectrum. Just one can have gentle symptoms that could be not leading to a whole good deal of functional impairment in terms of get the job done or school or every day everyday living to extra serious indications that are actually earning it pretty difficult or difficult to function successfully at function or at college or in your day to day life and may possibly even lead to security fears, problems that might suggest you want a larger level of care. So based on the signs and symptoms, a therapy could possibly consist of psychotherapy, which can incorporate things like cognitive behavioral therapies, or motivational threrapies, or much more intense physco threapies, or medications which may consist of anti-depressent prescription drugs, which are pretty successful and usually the mix of medications in pyschothreapy is often quite effective relying on the severity of signs. Most depressions are managed by primary care physcians, at the very least in the moderate phases, but occasionally, if signs are a lot more critical or if the intial attempts of treatment method are not effective, that might warrant a referral to a behavioral overall health expert.”

    At what level would you say somebody should really find out aid?

    Anfang: “So ordinarily, you would feel about any person who’s obtaining some functional impairment the place it is actually interferring in their capability to appreciate and be successful in their day to day daily life. You want to be aware of people indications that I talked about – sleep disturbance, hunger disturbance, energy, frustrated temper, irretability, tearfullness. Surely, if any person has views about emotion that they were far better off useless or ideas to damage on their own or have essentially tried out anything to damage themselves, that would be a serious purple flag warning indication to result in achieving out for assist and a good position to start is your main treatment medical doctor. That would be the very best place to start.”

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