Role of complementary therapies begins to expand for chronic kidney disease patients

Photo Cred: Deniz Altindas/Unsplash

By Judy Packer-Tursman

Researchers and clinicians in the Veterans Health Administration (VHA) and beyond are intensifying their exploration of how integrative health therapies might enhance treatment of patients with chronic kidney disease. This common illness, affecting approximately 37 million adults in the United States, is complicated to treat because most people are asymptomatic in its early stages, leaving the practitioner to work with sicker patients by the time care is sought.

Conventional medicine takes a broad approach for kidney disease patients that may include new and/or established medications, nutritional counseling, and efforts to promote behavioral changes such as increased physical activity, smoking cessation, and stress reduction.

The logical next step for practitioners is combining mainstream and complementary treatment modalities not only to enhance quality of life, but also to slow kidney disease progression by “unlocking the body’s natural ability to heal,” said Wayne Jonas, MD, executive director for integrative health programs at the Samueli Foundation.

Jonas, a practicing family physician with four decades of experience, said “there’s no question” complementary treatments “can help every step of the way” over the disease’s long trajectory. He said studies suggest benefits from several therapies with minimal side effects, including acupuncture to reduce levels of creatinine, the protein produced as waste by muscles that builds up if kidneys are damaged.

He also cites yoga to ease stress, help manage pain and, when practiced regularly in combination with conventional medicine, decrease blood pressure; moving meditations, including tai chi and qigong, to build balance, coordination, strength, and functional capacity; energy healing, such as reiki, to restore the body’s balance and improve its ability to heal; and judicious use of vitamins and supplements to ensure the body maintains a healthy level of nutrients.

“Our fundamental error is we try to isolate individual factors to find the ‘magic bullet,’” Jonas said. “We need to take a holistic approach.” He added, “the research continues and…the evidence is growing” to spur nephrologists’ increased use of integrative therapies, similar to how many cardiologists, oncologists, and neurologists treat their patients.

Nephrologist Paul Palevsky, MD, president of the National Kidney Foundation, agrees benefits might arise from incorporating complementary therapies and conventional medicine for kidney disease patients. But he cites the ongoing need for rigorous studies to determine a therapy’s efficacy in relieving symptoms and slowing disease progression (which he considers less likely).

“I think there’s a growing recognition of the value of combining these more holistic approaches with standard medical management, and there’s evidence in oncology in particular where these therapies have been done with chemo…for better quality of life,” said Palevsky, professor of medicine at the University of Pittsburgh School of Medicine and chief of the VA Pittsburgh healthcare system’s renal section.

In fact, Palevsky said complementary therapies, to the extent they help mitigate stress and control blood pressure, “could play a major role in improving quality of life” for patients with kidney disease in early stages and help manage stress and depression in patients on dialysis, many of whom have pain issues.

“I have to admit I have not been actively encouraging these therapies. [But] if the patient brings them up, I don’t discourage them,” unless something such as overuse of high-dose vitamin C might put them at risk, Palevsky said.

To put this into context, Palevsky noted he primarily treats hospitalized patients with acute kidney injuries, including those in intensive care. “So, in my own practice this [i.e., complementary treatment] is not something I’ve incorporated, but I’m intrigued how it may be incorporated for outpatient chronic kidney disease patients [and] patients on dialysis,” he said.

Palevsky said as part of leadership for the VA’s national kidney program, he has been involved in recent calls about working with the VA’s Whole Health program that focuses on mental, emotional, and spiritual needs as well as physical needs to improve veterans’ care.

“We actually settled upon the dialysis population and trying to deal with symptom management as a potential area” for a more holistic approach, Palevsky said. Some VA sites have expressed an interest, he said, though it’s premature to discuss specific therapies under consideration.

Nephrologist Jeanie Park, MD, MS, a hypertension specialist, is principal investigator of a federally funded study, which began in 2019, exploring mindfulness-based stress reduction for patients outside the VA system as well as veterans with chronic kidney disease and hypertension.

Elevated sympathetic nervous system activity is a major factor contributing to increased cardiovascular risk in kidney disease patients. Park said the randomized, controlled trial is testing whether an eight-week mindfulness meditation program, including yoga and stretching, improves sympathetic function and lowers blood pressure. If so, a larger trial expected to begin in August would see whether transcutaneous vagus nerve stimulation optimizes mindfulness meditation’s effects and restores patients’ autonomic balance.

“I think that we have seen some really promising data, but there’s not enough data for us to say this should be part of standard of care,” said Park, associate professor of medicine at Emory University School of Medicine and staff physician at the Atlanta VA.

Yet Park said she sees “definitely a lot of opportunity” in continuing to explore non-pharmacologic treatment options for kidney disease patients.