Tag: Kidney

How can I improve kidney health? Tips for water intake, diet and more.

Remark

Q: How can I preserve my kidneys healthful? Should really I consume more water for my kidneys to purpose far better?

A: Around 37 million folks — a lot more than 1 in 7 — in the United States have long-term kidney illness (CKD). What is about is that 9 out of 10 individuals do not know that they have CKD.

To keep your kidneys healthful, it is essential to initially realize the triggers and hazard elements connected with kidney disease.

Our kidneys execute numerous critical responsibilities in our overall body. As Homer Smith, a physiologist and science writer, famously stated, “The kidney is the organ par excellence of evolution.”

They regularly filter the blood that traverses as a result of them of squander merchandise and acid that are produced from different chemical reactions in the entire body.

They keep suitable blood stages of electrolytes this sort of as sodium, potassium, calcium, magnesium and phosphorus as a result of absorption and excretion by way of subunits termed nephrons. The preservation of these electrolyte concentrations is necessary for ideal working of many essential organs these as the coronary heart, brain and muscle tissue.

The kidneys control blood force via regulation of salt and water and production of hormones.

The kidneys also secrete hormones that are accountable for conservation of bone health and continual generation of red blood cells (the oxygen-carrying component of the blood).

When the kidneys fall short to accomplish these jobs, a lot of other organs and our total health are impacted. CKD is regarded as just one of the major causes of loss of life globally. And as a result, previously detection, mitigation, and treatment method of modifiable triggers and risk factors of CKD is significant.

Triggers and hazard variables of chronic kidney disorder

Signs related with CKD — these kinds of as nausea, vomiting, bodyweight loss, decreased appetite and generalized malaise — frequently manifest when the illness is in its advanced stages. And so, it is even extra pertinent to undertake screening assessments if you have any hazard aspects connected with CKD.

Elevated blood stress (hypertension) and diabetes are the foremost leads to of CKD. And heart sickness, weight problems, cigarette smoking cigarettes, ethnicity (African Us residents and Hispanics have a larger possibility of producing CKD), family historical past of CKD and irregular kidney process anatomy are the primary possibility elements.

If you have any of these circumstances or risk things, your physician should periodically check blood and urine laboratory indexes that could detect onset of CKD. These tests include things like a glomerular filtration level (a measure of how properly your kidneys are performing) and urine albumin (an early marker of kidney sickness).

Use of particular around-the-counter drugs, this kind of as nonsteroidal anti-inflammatory medications, including ibuprofen, naproxen and diclofenac, and proton pump inhibitors, together with pantoprazole and omeprazole, is affiliated with a possibility of creating CKD. If you are working with these prescription drugs on a frequent foundation — which differs from particular person to person — you need to talk about it with your physician, especially if you have any danger components for CKD.

How to keep your kidneys nutritious

Considering the fact that many circumstances of hypertension and diabetic issues occur from specified nutritional alternatives, together with salt intake, and fat gain, earning much healthier possibilities can have a downstream result of lowering your risk of developing CKD.

A eating plan substantial in fruits, vegetables and reduced-extra fat dairy merchandise (the Sprint eating plan) has been demonstrated to have a sizeable result in lessening blood strain. This eating plan merged with salt reduction lowers the risk of hypertension, Sort 2 diabetes, cardiovascular condition, stroke and mortality.

Exploration at Johns Hopkins College that followed over 15,000 grown ups for 20 many years, has demonstrated that the Sprint eating plan could lower the threat of establishing kidney sickness. This study also found that men and women with a superior intake of pink and processed meats had a greater danger of establishing CKD.

A plant-based or vegan eating plan has also been proven to prevent kidney ailment and slow its progression.

Due to the fact workout is helpful in mitigating different results in and hazard elements, this kind of as hypertension, diabetic issues and cardiovascular sickness, connected with kidney disorder, its effects have been examined in the significant-scale Nationwide Wellbeing and Nourishment Examination Study (NHANES). People with greater amounts of bodily activity calculated by an accelerometer and a questionnaire ended up far more probably to have healthier kidney function.

The Nationwide Kidney Foundation suggests that persons with CKD work out at the very least a few nonconsecutive days a 7 days, making up to 30 minutes for each session.

Does growing h2o intake reduce risk of kidney ailment?

As nephrologists, we are routinely asked if raising drinking water ingestion, outside of normal tips, has an outcome on strengthening kidney functionality.

A research that examined drinking water consumption in patients with CKD confirmed that escalating water use by in excess of 1 liter (about 34 fluid ounces) for each day did not lessen development of kidney illness. There is also no robust evidence to recommend that enhanced water intake helps prevent CKD.

Enhanced fluid intake, nevertheless, is involved with reduction in the formation of kidney stones. Commonly establishing kidney stones may perhaps maximize the hazard of kidney sickness.

The National Academy of Drugs implies a fluid consumption of just about 100 ounces per working day in males and 70 ounces per day in ladies (this becoming a tutorial for ingestion rather than a each day objective). Elevated bodily exercise and exposure to hotter temperatures warrants an raise in this recommended volume, even though patients with sure healthcare problems and lessen weights should lower intake.

There is no 1 measurement that suits all for h2o consumption, but the normal advice is easy — consume to thirst with regulation based mostly on activity and local weather.

Meet the medical practitioners: Sam Kant is a typical and transplant nephrologist, and an assistant professor of drugs at the Division of Nephrology and Extensive Transplant Center at Johns Hopkins College University of Medication.

Natasha Dave is a nephrologist and healthcare director at Strive Overall health.

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February 23, 2023

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.

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	QDDHG^a 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 medication^b 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 reduction^a/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 granule^b BID x 24 weeks. T₂: TCM granule^b 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 granule^c 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 medication^d 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) v5.0^a,b,c			Onset of adverse effects (if available)	Management and outcomes of patients
Study (year)	N (T)	Treatment	Grade 1 ({fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c})	Grade 2 ({fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c})	Grade 3 ({fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c})	Onset of adverse effects (if available)	Management and outcomes of patients
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	QDDHG^b 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 medication^cadministered	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 tablets^a 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	Proteinuria
	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	Uremic pruritus
	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 medication^b administered x 60 days; Brazilian green propolis pills BD x 3 months	Uremic pruritus	-41.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to -29.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}	–
Homeopathy (n=2) [16,64]		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.

January 18, 2023

4 health tips to help you slow down the progression of kidney diseases | Health

To keep overall health and fitness and well-becoming, we should be cautious about all our system organs, particularly the kidneys, which are fist-like organs observed underneath the ribs and positioned on the two sides of the spine. They help our overall body to filter extra fluids and wastes efficiently, thereby putting a wholesome harmony of water, salts, and minerals this sort of as sodium, calcium and phosphorus in our blood.

Kidneys also assist in managing blood strain and keeping the overall health of bones. However any small imbalance in the performing of kidneys ordinarily goes undetected owing to deficiency of any main symptoms and may silently continue to innovative kidney condition consequently, it is so significant that a single goes via regular lab tests and investigations.

In an interview with HT Way of living, Dr Saurabh Pokhariyal, Co-Founder of VitusCare Dialysis Middle, described, “Regular kidney check out-ups are necessary for those people who either have diabetes, cardiovascular troubles, substantial blood force, being overweight or a household historical past of kidney condition. By frequently screening kidney operate, one can comprehend one’s kidney well being and an early prognosis of any kidney relevant concern can enable in running any future hurt, improved. The incidence of CKD in India is unclear thanks to the deficiency of correct nationwide details selection.”

He pointed at the number of experiments that have approximated that more than 1 million new people have been identified with Conclude-Phase Kidney Illness (ESKD) who want to possibly decide for dialysis therapy or undertake a kidney transplant. In addition, almost .2 million people are finding additional to this pool every single calendar year owing to the improved incidence of life style conditions this sort of as diabetes and hyper-stress that are the key precursors to kidney disease.

In accordance to Dr Saurabh Pokhariyal, “Thankfully, altering some life style functions can also help hold off kidney damage, specifically if long-term kidney condition (CKD) is identified in 1 of the early phases.” He shared some of the suggestions we need to abide by to gradual down the progression of kidney diseases:

1. Decide for standard physical action – A fifty percent-an-hour typical workout is vital for a wholesome entire body as cardio work out can help in keeping optimum cardiovascular health and fitness and also aids to lessen blood stress and blood sugar which are the two principal will cause of kidney sickness . Work out routines these as brisk-going for walks, functioning and/or cycling can be valuable for the well being of the kidneys. One can opt for these functions based upon the curiosity and as for every recommendation and acceptance by the referring medical professional.

2. Be watchful with OTC nutritional supplements and medication – Take medicine only just after the doctor’s suggestion. Having painkillers frequently without consulting medical professionals about a very long interval might induce long-term kidney illness. Look at taking More than-the-counter (OTC) painkillers only in situation the agony is unbearable. In scenario the discomfort in any of the areas is a recurring one, just one have to check with a normal doctor for even further prognosis.

3. Monitor your blood glucose degree – If you have diabetes, controlling your blood sugar amounts can aid slow the progression of kidney disease. Converse to a nutritionist to master far more about the food items things/dishes that can be eaten in scenario of diabetes or kidney sickness. Follow the doctor’s guidance linked to diet regime, insulin and other remedies consistently.

4. Regulate your blood stress – Maintaining your blood tension within a balanced variety may perhaps help sluggish down the development of kidney disorder. Way of living changes these kinds of as maintaining a healthy weight, performing exercises, meditating, taking in significantly less salt and alcoholic beverages, and quitting cigarette smoking can help reduce your blood stress. If you are diagnosed with substantial blood stress, your health care provider may perhaps prescribe blood force treatment in addition to creating way of living modifications.

June 2, 2022
Health expert lists diet tips for hypertension patients to avoid kidney diseases | Health

Environment Hypertension Day is noticed annually on Could 17 to educate the masses about the sick-consequences of hypertension or significant blood pressure on the human body and this 12 months, the topic is ‘Measure your blood force properly, manage it, dwell longer’ which demonstrates on combatting minimal recognition level and make extra and a lot more awareness about the illness and its management. According to a examine published in the Lancet journal, India is ranked 156 and 164 globally in conditions of hypertension prevalence among the guys and ladies respectively.

Did you know, around two-third of the scenarios of persistent kidney illness in western nations around the world are on account of substantial blood stress and diabetes, the estimate in India is about 40–60{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} till nowadays? Our kidneys are each the victim and the lead to of hypertension and large blood strain is 1 of the most prevalent triggers of kidney ailments currently.

In an interview with HT Way of living, Apeksha Ekbote, Main Dietician at NephroPlus, stated, “Hypertension or large blood stress triggers problems to the very small blood vessels that filter blood in the kidney, producing removing of squander from the physique difficult and thus ensuing in a broken kidney. When the perform of kidneys starts to fall short, they can result in even further increase in blood tension by releasing certain hormones or by creating retention of salt and h2o in your body.”

She additional, “One who is hypertensive may well not know that they have a kidney ailment right up until their blood is tested for Blood Urea, Serum Creatinine and GFR. It is an exceptionally essential parameter that each individual hypertensive particular person ought to be tested for at least when in six months irrespective of their age to examine for their renal perform. For patients who have large blood stress and kidney condition, it is extremely essential to hold a control look at on their blood force by their life-style adjustments. It is extremely imperative to adhere to a rigorous diet program.”

She insisted that the most frequent guidance is to prohibit salt/sodium which by yourself is not the only thing to do but it is critical to have an understanding of to follow a Sprint i.e. Dietary Method to Prevent Hypertension diet plan. She stated, “Inclusion of Dash, remaining nicely hydrated and indulging in physical activity of 45 minutes for every working day not only controls blood force and helps prevent kidney illnesses but also retains a look at on your pounds and general properly-getting.”

According to Dietician Apeksha Ekbote, Dash or Dietary Strategy to Halt Hypertension incorporates, “Salt-controlled diet program, significantly less consumption of sodium abundant meals, take in clean fruits and greens, increase complete grains to the meal, steer clear of refined cereals and grains, steer clear of saturated meals goods and organ meat and stay away from packaged and canned food items things.”

May 16, 2022
Burst wave lithotripsy may provide an effective alternative for noninvasive treatment of kidney stones

An impressive procedure called burst wave lithotripsy (BWL) may present an effective, extra obtainable alternative for noninvasive remedy of kidney stones, according to original human studies noted in The Journal of Urology^®, an Official Journal of the American Urological Affiliation (AUA). The journal is posted in the Lippincott portfolio by Wolters Kluwer.

Applying targeted ultrasound bursts to break up kidney stones, BWL offers a promising new tactic to staying away from the superior expenses and healthcare burden of kidney stone treatment, in accordance to the report by Jonathan Harper, MD, of College of Washington Faculty of Drugs and colleagues. They produce, “New BWL technological innovation correctly fragmented stones of a selection of measurements, places and densities to less than two-millimeter fragments in 10 minutes with negligible tissue injury.”

Toward new place of work-based treatment method technique for kidney stones

Kidney stones are a incredibly widespread condition, impacting 1 in 10 People at a price of $10 billion for every year. Although many stones go on their have, other remedies are in some cases needed. Some reasonably tiny stones can be handled employing a technique called extracorporeal shock wave lithotripsy (ESWL), applying shock waves to split up the stones so that they will be far more most likely to move on their possess. The ESWL technique is performed in a hospital or clinic, usually with the affected person below sedation.

In contrast to the shock waves employed in ESWL, the BWL treatment employs “short harmonic bursts” of ultrasound strength – possibly allowing for the stones to be damaged up in a shorter method without having the will need for sedation or anesthesia. Pre-medical scientific tests supported the effectiveness of BWL in breaking up experimental stones of different measurement and composition.

For the subsequent action in acquiring the treatment, Dr. Harper and colleagues performed first research in human clients with kidney stones. The patients ended up undergoing a surgical course of action, termed ureteroscopy, that is utilised to address bigger stones. Just before that cure, the stones were dealt with with a shorter time period of BWL – no for a longer time than 10 minutes. Using the ureteroscope, the researchers have been in a position to directly observe how nicely the ultrasound waves labored in breaking up stones, as effectively as observing any injuries to the kidney tissues.

In the examine, BWL was utilized in 19 patients to focus on 25 confirmed stones. Overall, a median of 90{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the stone volume was absolutely broken up (comminuted) in just the transient cure interval. Thirty-9 percent of stones had been wholly fragmented though 52{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} were partly fragmented.

Most of the stone fragments calculated significantly less than two millimeters – tiny more than enough that they would be effortlessly capable to go on their possess, with no a lot ache. Examination through the ureteroscope confirmed delicate or no tissue damage linked to the BWL process, consisting largely of gentle bleeding.

For various motives, BWL could be an vital functional advance in the management of kidney stones. Quite a few people make many visits to the unexpected emergency department when waiting around for definitive treatment method of their kidney stones, often requiring opioids for ache administration. Some patients need recurring treatment method, even following surgical treatment or ESWL. “The ability to noninvasively crack stones and expel the fragments in awake people at very first presentation in the ED or clinic has the opportunity to give just-in-time therapy major to a reduction of the over-all suffering, value and source burden connected with a stone party,” scientists create.

The new success “are a phase toward an office environment-dependent lithotripsy for awake people,” Dr. Harper and coauthors conclude. They strategy additional scientific tests towards figuring out no matter if the BWL approach can meet up with their best intention of a “noninvasive, 30-moment therapy in the clinic with out anesthesia.”

The BWL know-how was accredited to SonoMotion which is producing a professional variation of the technological innovation and is in the midst of different scientific trials.

Resource:

Journal reference:

Harper, J.D., et al. (2022) Fragmentation of Stones by Burst Wave Lithotripsy in the Very first 19 People. Journal of Urology. doi.org/10.1097/JU.0000000000002446.

March 24, 2022
Adopt Healthy Lifestyle, Practice Yoga To Avoid Kidney Issues: Health Experts | Patna News

PATNA: There has been an alarming raise in serious kidney sickness with the recent modifications in life style and dietary behaviors of folks. A single out of 10 grownup suffers from kidney illness and at the very least just one member in every next or third family faces some form of nephrological ailment, say wellbeing professionals.
As the clinical establishments and well being societies of the state are gearing up to celebrate ‘World Kidney Day’ on Thursday, specialists warning the men and women versus indiscriminate use of drugs and junk meals which invariably brings about kidney illnesses. Early detection and treatment method can continue to keep long-term kidney ailment from acquiring worse, they say.
Dr Satish Kumar of Nalanda Professional medical Higher education Clinic reported a few to four decades ago kidney ailments were being not as rampant as noticed right now. Each and every second or 3rd property in any locality has a kidney patient currently. “Uncontrolled diabetic issues and hypertension typically presents increase to kidney ailments,” Dr Kumar claimed, adding that with the rising incidence of diabetes and hypertension, the serious kidney condition has also elevated considerably.
He additional pointed out that numerous medicine, particularly the discomfort killers, have facet-consequences and, hence, their extended-term use could adversely affect kidney’s health. “One have to assume twice before using any drug on the recommendation of medication shopkeepers or some quacks,” he stated.
Aryabhatta Information University’s medication college dean Dr Rajiv Ranjan Prasad noticed that kidney diseases are silent killers. They may possibly arise from social situations these kinds of as poverty, deficiency of education, occupational dangers and air pollution, but are mainly brought on by diabetic issues, superior blood pressure and other diseases. “Excessive use of medication without the need of receiving advice from registered medical practitioners typically guide to kidney problems,” he mentioned.
Dr Prasad extra that people today need to be encouraged to undertake wholesome diet and life to maintain very good kidney health. Nationwide planners and coverage makers should spend thanks consideration to the long-term kidney conditions for the welfare of the ailing humanity.
Dr Sampurnanad Tiwari, principal of Government Ayurvedic Higher education Healthcare facility, admitted that there has been a phenomenal increase in kidney conditions in latest many years primarily due to speedy shifting way of life and nutritional patterns. Indiscriminate use of fast food stuff and greater consumption of mutton and chicken typically give increase to kidney conditions.
“People need to exercise ‘yogic asanas’ and workouts and keep away from consuming extraordinary incredibly hot and cold food and beverages to stay guarded from kidney disorders,” Tiwari stated, introducing that people have to also get dealt with for chronic constipation and any obstruction in the urinary tract.

March 10, 2022

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

Methods

Results

Figure 1: Flow chart for the inclusion of articles in this systematic review.

Table 1: Characteristics of included AMS intervention studies.

Table 2: Assessment of outcomes and efficacy of different AMS interventions.

Table 3: Adverse effects reported with AMS usage.

Table 4: Summary of efficacy and safety profile of AMS indicated for CKD symptoms.

Discussion

Limitations

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Burst wave lithotripsy may provide an effective alternative for noninvasive treatment of kidney stones

Toward new place of work-based treatment method technique for kidney stones

Adopt Healthy Lifestyle, Practice Yoga To Avoid Kidney Issues: Health Experts | Patna News

Figure
1:
Flow chart for the inclusion of articles in this systematic review.

Table
1: Characteristics of included AMS intervention studies.

Table
2: Assessment of outcomes and efficacy of different AMS interventions.

Table
3: Adverse effects reported with AMS usage.

Table
4: Summary of efficacy and safety profile of AMS indicated for CKD symptoms.