http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628413/ Am J Kidney Dis. Author manuscript; available in PMC May 1, 2014. Published in final edited form as: Am J Kidney Dis. May 2013; 61(5): 739–747. Published online Feb 14, 2013. doi: 10.1053/j.ajkd.2012.12.018 PMCID: PMC3628413 NIHMSID: NIHMS435924 Americans’ Use of Dietary Supplements That Are Potentially Harmful in CKD Vanessa Grubbs, MD, MPH,1 Laura C. Plantinga, ScM,2 Delphine S. Tuot, MD, MAS,1 Elizabeth Hedgeman, MS, MPH,3 Rajiv Saran, MD, MS,3 Sharon Saydah, PhD,4 Deborah Rolka, MS,4 Neil R. Powe, MD, MPH, MBA,2 and Centers for Disease Control and Prevention CKD Surveillance Team* Author information ► Copyright and License information ► The publisher's final edited version of this article is available at Am J Kidney Dis Go to: Abstract. Background The prevalence in the United States of dietary supplement use that may be harmful to those with chronic kidney disease (CKD) is unknown. We sought to characterize potentially harmful supplement use by individual CKD status. Study Design Cross-sectional national survey (National Health and Nutrition Examination Survey, 1999-2008) Setting & Participants Community-based survey of 21,169 non-pregnant, non-institutionalized U.S. civilian adults (≥20 years) Predictor CKD status (no CKD, at risk for CKD [presence of diabetes, hypertension and/or cardiovascular disease], stage 1/2 [albuminuria only (albumin-creatinine ratio ≥30 mg/g)], or stage 3/4 [estimated glomerular filtration rate of 15-59 ml/min/1.73 m2]). Outcome Self-reported use of dietary supplements containing any of 37 herbs the National Kidney Foundation identified as potentially harmful in the setting of CKD. Measurements Albuminuria and estimated glomerular filtration rate assessed from urine and blood samples; demographics and comorbid conditions assessed by standardized questionnaire. Results An estimated 8.0% of U.S. adults reported potentially harmful supplement use within the last 30 days. Lower crude estimated prevalence of potentially harmful supplement use was associated with higher CKD severity (no CKD, 8.5%; at risk, 8.0%; stage 1/2, 6.1%; and stage 3/4, 6.2%; p<0.001). However, after adjustment for confounders, those with or at risk for CKD were as likely to use a potentially harmful supplement as those without CKD: at-risk OR, 0.93 (95% CI, 0.79 -1.09); stage 1/2 OR, 0.83 (95% CI, 0.64 -1.08); stage 3/4 OR, 0.87 (95% CI, 0.63 -1.18); all vs. no CKD. Limitations Herb content was not available and the list of potentially harmful supplements examined is unlikely to be exhaustive. Conclusions The use of dietary supplements potentially harmful to people with CKD is common, regardless of CKD status. Healthcare providers should discuss the use and potential risks of supplements with patients with and at risk for CKD. continued athttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628413/
Taking high doses of vitamin C (1 gram or more daily), for example, has been associated with an increased risk of kidney stones, especially in people with a history of kidney stones (see the Cautions section of the Vitamin C Review for more information). Supplementation with cranberry tablets may pose a similar risk in people with a history of kidney stones (Terris, Urology 2001). In diabetes patients with advanced kidney disease, high daily doses of B vitamins (folate, B6 and B12) were found in one study to worsen kidney function and double the risk of heart attack stroke and death (see the Cautions section of the B Vitamins Review for more information). Minerals such as potassium, calcium, magnesium and phosphorus also have the potential to affect kidney function. The National Kidney Foundation advises people with kidney disease, people who are on dialysis, and people who have received a kidney transplant to avoid all herbal supplements, and provides a list of supplements that may be the most harmful. The foundation also warns that some minerals, like potassium, may be present in supplements in which you may not expect them, like turmeric rhizome, evening primrose, noni and garlic leaf can all contain potassium. Heavy metal contamination from supplements is another potential cause of kidney problems (Gabardi, Clin J Am Soc Nephrol 2012). Long-term exposure to excessive cadmium (which accumulates in kidneys), for example, can cause irreversible kidney damage and may also weaken bones. ConsumerLab.com has reported surprisingly high concentrations of cadmium in some popular cocoa powders. To avoid unnecessary exposure, it's best to use supplements that have been tested by an independent testing organization, like ConsumerLab.com, to be sure that a supplement does not exceed heavy metal limits.
This is good to be aware of, but not surprising. I've been concerned by the accumulation of listed inert ingredients when taking many supplements. The kidneys have to process all that, too. And you've brought up the good point that there may be substances that aren't listed.
It should be said at the same time, many if not most medications are also risky if you have kidney or liver disease. Antivirals for example, though generally well tolerated may not be ok for people with kidney disease. This is a geeat reason to keep the family dr in the loop with all meds. Specialists just don't seem to ask a lot of questions about general health ime.
Can there be any patient with known kidney conditions whose physicians haven't already warned them not only about the taking of vitamins, minerals, and suppllements, but also about the associated hazards of many prescribed drugs from other physicians? Is this an article that holds patients responsible for deciding what substances to consume; or is it a warning to nephrologists to be even more diligent in cautioning their patients about taking stuff, alterternative, prescribed, or otherwise? And how would this apply to any topic on this board, inasmuch as I and others recommending vitamins, minerals, supplements, or drugs virtually always advise first getting approval of a medical professional? That's only common sense. --John of Ohio
The contention that elevated intake of vitamin C will cause kidney stones is no longer well-supported. All current clinical evidence finds that vitamin C intake does not restrict or result in kidney stones. Lots of cogent info here: http://lpi.oregonstate.edu/f-w99/kidneystones.html "Over twenty years ago, Linus Pauling proposed that the RDA for vitamin C should be increased to 200 mg/day. At about the same time, he mustered theoretical and experimental arguments to support his belief at that time that the optimal intake for humans is about 2 grams/day. While the merits of ingesting that much vitamin C or more each day are debatable, at least we can be confident that large doses are not harmful for healthy people and may be of therapeutic benefit in many cases. In particular, the concern about the role of vitamin C in kidney stone formation, a source of speculation for several decades, appears to be no longer justified." --John of Ohio
It is pertinent to this forum since many of us take herbs and supplements in general, I got this as an email alert and felt the forum members should be aware of these risks ,as the article stated drs are not diligent enough about asking their patients about supplements and herbs they are taking so people who have kidney issues might not be aware of these risks.
and John members are taking herbs and supplements on this board for other reasons than your regime so don't take these types of posts so personally.
I take supplements on a regular basis. They've been beneficial in my case. I don't take many and not in huge doses but I do take more than the FDA recommended dose of vitamin C.
I am sure they are beneficial to many but if someone has a condition and are not aware of the risks, they should be.
One of the reasons why I feel people need to be aware of risks, besides it important to know. I developed a life threatening food allergy because I did not know something, and no doctor ever told me. There is a strong belief by the top doctors in the field of allergy and immunology that antacids especially proton pump inhibitors can cause a food allergy. I never took any of them in my life until 3 years ago when my gastro dr prescribed it for me. Well a couple of months into taking them I got an Anaphylaxic reaction to eating just 1 shrimp. I have eaten shrimp all my life. I didn't eat my dinner because it was too spicy for me, if I had I would have probably died. I am sure I had a guardian angel looking out for me that night. Now my life is completely turned upside because of it. Any kind of cross contamination can hurt me, possibly kill me. I stopped eating in restaurants because I am too scared to trust them to keep me safe. I need to read every label of every food item I buy and call manufacturers to see if it was made on shared equipment with shellfish, just to name a few things that turned my world upside due to this food allergy. If my doctor would have warned me about this risk of taking a proton pump inhibitors which was prescription Prilosec, I could have avoided all of this. Knowledge is important especially about things we put into our bodies.
Exactly. I know I always check with my doctor before taking any vitamins or supplements due to the various health conditions and medications I have. Keep posting Vicki, knowledge is power.