Internet Claims on Dietary and Herbal Supplements in Advanced Nephropathy: Truth or Myth

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; The use of complementary/alternative medicine has garnered rising interest in recent years. Natural products including herbs, vitamins, and minerals are the most popularly consumed. The Internet is a ubiquitous source of information/market for these supplements. &lt;b&gt;&lt;i&gt;Aim:&lt;/i&gt;&lt;/b&gt; To systematically evaluate the dietary and herbal supplement recommended for patients with CKD and ESRD on the Internet, and try to distinguish between the claim of the manufacturer and proven scientific data. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; A questionnaire assessing each website was formulated. Each product ingredient was recorded in the questionnaire by two independent reviewers and statistically analyzed. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Of the 184 websites, 28% claimed to decrease CKD progression, 60% did not advise to consult a doctor before taking the supplement, and &gt;90% did not mention any potential drug interaction, disease interaction, or caution in use during pregnancy or in children. The ten common plant ingredients claiming to be beneficial in kidney diseases were uva ursi, dandelion, parsley, corn silk, juniper, celery, buchu, horsetail, marshmallow, and stinging nettle. In contrast to their claims, these substances were not adequately studied in humans. The available animal studies showed detrimental effects and potential drug interactions with commonly used medications in the CKD/ESRD population. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; Nephrologists need to be cognizant of the lack of substantiated proven benefits of these substances and of the potential adverse effects in the animal models that can translate to the patients. Most importantly, the policy needs to change regarding the regulation of these products to prevent patient harm and misinformation. i 2014 S. Karger AG, Basel</jats:p

Pulmonary Embolization with Tunneled Hemodialysis Catheter-Associated Blood Stream Infection: The Perils of Systemic Anticoagulation

A 35-year old African-American male with end-stage renal disease on hemodialysis through a tunneled dialysis catheter (TDC) presented with fever, diffuse aches and generalized distress. Blood cultures (BC) were obtained and empirical broad-spectrum antibiotic therapy started. After urgent renal dialysis, TDC was pulled at the bedside. Chest computed tomography (CT) diagnosed pulmonary embolism and systemic i.v. heparin was initiated. BC grew Gram positive cocci (methicillin-sensitive S. aureus) and cardiac echocardiogram confirmed acute bacterial endocarditis. Due to declined mental status, CT imaging was obtained revealing massive intracranial hemorrhage leading to the patient's death. Further chest CT review revealed only hemodynamically non-significant pulmonary emboli in some segmental and subsegmental arteries. Pulmonary embolization may be an expected occurrence with removal of infected TDC; systemic anticoagulation may not be warranted in such cases and may lead to catastrophic intracranial hemorrhage. This case draws our attention to the perils of rigid adherence to protocol and the failure of considering the needs of special patient cohorts and individualized care. </jats:p