FP366THE PATTERNS AND ASSOCIATIONS OF COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) USE AMONG PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD) AND KIDNEY TRANSPLANT RECIPIENTS

Abstract

Introduction and Aims: CAM use is prevalent and rising among the general population and patients with chronic medical disorders accounting for almost 20% of the drug market turnover in the USA. Some of these practices have been claimed to be useful for treatment of hypertension, diabetes and kidney disease. However some herbal therapies can be harmful to patients with CKD. Few studies have explored the patterns of CAM use among CKD patients and the rationale for their use as well as their impact on the patients' interaction with modern medicine. Even less is known about the difference in patient attitude towards CAM among various subsets of CKD patients including transplant recipients. Methods: We performed a multicentre survey which included a face to face interview with patients with CKD patients on an out-patient basis including those with CKD stages 3-5, CKD patients on hemdialysis and kidney transplant recipients. The survey inquired about epidemiological data, types, sources and patterns of CAM used as well as the effect of CAM use on the patients' interaction with the medical system and therapy. Results: A total of 1005 subjects were included in the study including 560 predialyis patints with CKD 3-5, 245 patients on hemodialysis and 200 transplant recipients. Overall, 551 patients (54%) were using CAM (64% of predialyis patients, 33% of hemodialysis patients and 55% of transplant recipients, p<0.001). Herbal therapy was the most commonly used type of CAM (88%), followed by acupuncture and spiritual therapies (11.4%) and magic (1.6%). CAM users were more likely to be males (O.R. 1.6; 95% CI 1.3-2); employed (O.R. 1.9; 95% CI 1.4-2.4); urban residents as opposed to rural (O.R. 1.7; 95% CI 1.4-2.2), have a higher income (O.R. 3; 95% CI 2.4-4.3) and higher than secondary school education (O.R. 1.6; 95% CI 1.2-2). Most prescriptions of CAM were made by a herbalist (68%) and 98% of those obtained from traditional herb shops in the form of raw identifiable herbs in 98.7 % of cases or unknown mixtures in the rest. The rationale for CAM use was trust in its efficacy (51.5%), lower cost (29.5%) and frustration with modern medicine (19%). Compliance to medical treatment was affected by CAM use in 3% of patients including one transplant patient with deteriorating kidney function. Only 17% informed their physicians about their practice mainly because they were not inquired patients, however transplant recipients were more likely to report p<0.001. Most commonly used herbs were Nigella sativa, Hibiscus sabdarifa and Cymbopogon proximus. Potentially harmful CAM included intake of liquorice and vinegar. Conclusions: CAM use is highly prevalent among CKD patients particularly predialysis CKD. Some of these practices are potentially harmful and may affect patient compliance to modern medicine. Physicians commonly ignore to inquire these practices which frequently reflect patient frustration with modern medicine efficacy and/or price.