Why A Naturopath for Kidney Support?
Unfortunately, unless you have late-stage kidney disease, it’s very unlikely you will get a referral to see a nephrologist (a kidney specialist). Most medical guidelines for doctors in Canada and Ontario recommend that referrals only be made to a nephrologist once kidney function has dropped to around 30%. (1 , 2 , 3 , 4) Even when a kidney referral is done, half of individuals in Canada wait over 3 months to see the nephrologist, and a quarter wait nearly a year (according to a 2020 Canadian study). (5) In Canada, nephrology referral wait times are longer than 80% of all other medicinal specialties. (6) The point is - it’s only once kidney function is mostly gone that a person sees a nephrologist and can begin implementing more specialized preventative strategies. Meanwhile, there are multitude of lifestyle, dietary and natural therapies that have been shown in research trials to delay progression and reduce risk of end stage renal disease.
Evidence suggests that if we want to help prevent late stage kidney disease, we should begin looking at diet and therapies in the early stages, and not wait until late stage disease has already occured. Many of the preventative recommendations by kidney organizations, such as the National Kidney Foundation, are in early stage disease. (7) One study from 2009 in particular found that early-stage kidney disease patients on alkali therapy had a lower rate of kidney disease progression. Patients on alkali therapy had a 6.5% risk of end stage renal disease, compared to a 33% risk in the patients who did not take alkali therapy. (8) Bear in mind, context is very important - the patients in this trial were tested and found to have high levels of acidity as defined by their bloodwork. Currently there is little evidence alkali therapy provides benefit to those who are already alkaline and in fact altering the body’s acidity level too far can be unsafe. Blood testing can help determine if alkali therapy is indicated and help reduce risk of dosing too high. It’s also important to mention that the 2009 study was a smaller trial and larger studies won’t likely find quite the same impact. That said, a larger 2020 study summarized the results of 15 trials together and found very significant results - that the average risk of end stage renal failure dropped to about half in those undergoing alkali therapy. (9)
Then there is diet, which can get very complicated quickly. In 2017, a study compiled the results of several studies and found that even just protein intake alone can make a very significant impact in early stage kidney disease. (10) For example, here’s one of the studies in the analysis - it found a 1.2% decrease in kidney function for every 10 grams of animal protein consumed per day. (11) Here’s another study from 2012, that found people who consumed lower amounts of protein overall had slower progression. (12) A person’s optimal diet is a delicate balance however and some evidence suggests that consuming too low protein can also adversely affect health. (13) The right amount of protein depends on the person, the stage of disease and whether any other forms of kidney disorders are present.
All this is just scratching the surface however. Diet and testing aside, there are over 100 different natural therapies that have been studied in kidney diseases and disorders. That being said, only a handful of them have been shown to significantly and consistently improve kidney function across studies. Other therapies in the wrong contexts either have no impact or have been shown to even possibly worsen kidney function. (14 , 15) Due to the complexity of the kidneys, it is very important to talk to a health professional before considering any natural therapies.
There are a wide range of kidney tests and therapies available. If you would like to learn more, feel free to reach out to Dr. Baker (ND) here.
(1) Hingwala J, Wojciechowski P, Hiebert B, Bueti J, Rigatto C, Komenda P, Tangri N. Risk-Based Triage for Nephrology Referrals Using the Kidney Failure Risk Equation. Can J Kidney Health Dis. 2017 Aug 9;4:2054358117722782. doi: 10.1177/2054358117722782. PMID: 28835850; PMCID: PMC5555495.
(2) Outpatient Nephrology Referral Form for Primary Care Providers. https://www.niagarahealth.on.ca/files/KidneyWiseToolkit.pdf
(3) Approach to the detection and management of chronic kidney disease. https://www.cfp.ca/content/cfp/64/10/728.full.pdf
(4) Brimble KS, Boll P, Grill AK, et alImpact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluationBMJ Open 2020;10:e032838. doi: 10.1136/bmjopen-2019-032838
(5) How long are Canadians waiting to access specialty care? https://www.cfp.ca/content/cfp/66/6/434.full.pdf
(6) How long are Canadians waiting to access specialty care? https://www.cfp.ca/content/cfp/66/6/434.full.pdf
(7) Nutrition and Early Kidney Disease (Stages 1–4). https://www.kidney.org/atoz/content/nutrikidfail_stage1-4#potassium
(8) de Brito-Ashurst, Ione et al. “Bicarbonate supplementation slows progression of CKD and improves nutritional status.” Journal of the American Society of Nephrology : JASN vol. 20,9 (2009): 2075-84. doi:10.1681/ASN.2008111205
(9) Hultin, Sebastian et al. “A Systematic Review and Meta-Analysis on Effects of Bicarbonate Therapy on Kidney Outcomes.” Kidney international reports vol. 6,3 695-705. 31 Dec. 2020, doi:10.1016/j.ekir.2020.12.019
(10) Gluba-Brzózka A, Franczyk B, Rysz J. Vegetarian Diet in Chronic Kidney Disease-A Friend or Foe. Nutrients. 2017 Apr 10;9(4):374. doi: 10.3390/nu9040374. PMID: 28394274; PMCID: PMC5409713.
(11) Knight, Eric L et al. “The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency.” Annals of internal medicine vol. 138,6 (2003): 460-7. doi:10.7326/0003-4819-138-6-200303180-00009
(12) Scialla JJ, Appel LJ, Astor BC, Miller ER 3rd, Beddhu S, Woodward M, Parekh RS, Anderson CA; African American Study of Kidney Disease and Hypertension Study Group. Net endogenous acid production is associated with a faster decline in GFR in African Americans. Kidney Int. 2012 Jul;82(1):106-12. doi: 10.1038/ki.2012.82. Epub 2012 Apr 4. PMID: 22475819; PMCID: PMC3540413.
(13) Menon, Vandana et al. “Effect of a very low-protein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study.” American journal of kidney diseases : the official journal of the National Kidney Foundation vol. 53,2 (2009): 208-17. doi:10.1053/j.ajkd.2008.08.009
(14) Firouzi, Somayyeh, and Fahimeh Haghighatdoost. “The effects of prebiotic, probiotic, and synbiotic supplementation on blood parameters of renal function: A systematic review and meta-analysis of clinical trials.” Nutrition (Burbank, Los Angeles County, Calif.) vol. 51-52 (2018): 104-113. doi:10.1016/j.nut.2018.01.007
(15) Rodríguez-Fierros, Félix Leao et al. “Modulation of Renal Function in a Metabolic Syndrome Rat Model by Antioxidants in Hibiscus sabdariffa L.” Molecules (Basel, Switzerland) vol. 26,7 2074. 4 Apr. 2021, doi:10.3390/molecules26072074
