Chronic Kidney Disease

What is Chronic Kidney Disease?

Chronic kidney disease (CKD) is kidney damage, or a kidney filtering rate (eGFR) below 60, that lasts three months or more, whatever the cause.^[1] Nearly 14 percent of Americans have it.^[2] CKD needs medical care, and this page describes only the supportive role complementary care may play.

Common symptoms

Early CKD often causes no symptoms and is found through blood and urine tests. As kidney function declines, people may notice tiredness, swelling in the legs or around the eyes, itching, poor sleep, nausea, reduced appetite and changes in urination.^[1] Restless legs and low mood are also common in people with advanced disease.^{[3, 4]}

Causes and risk factors

Diabetes and high blood pressure are the most common causes in the United States, and the interplay among heart, kidney and metabolic health is increasingly recognized.^[2] Other causes include inflammation of the kidney's filters, inherited conditions such as polycystic kidney disease, long-term blockage of urine flow and some medicines.^[1] Older age, obesity and a family history of kidney disease raise risk.

How it is diagnosed and treated conventionally

CKD is diagnosed with blood tests for eGFR and urine tests for albumin, and it is staged from 1 to 5 according to eGFR and the amount of albumin in the urine.^[1] A nephrologist or primary care physician makes the diagnosis and stages it.

Treatment aims to slow the loss of kidney function, prevent heart and blood vessel disease, and manage complications such as anemia, bone and mineral problems and acid or potassium imbalances.^[2] Newer medicines can help with several of these goals at once.^[2] When kidney function falls to stage 5, treatment is dialysis or a kidney transplant.^[1]

Why Chronic Kidney Disease calls for a whole-person approach

Kidney function depends mostly on blood pressure, blood sugar and the underlying cause, all of which your physicians manage. CKD also affects how a person feels each day, and that is where supportive care may help.

The more advanced the disease, the more symptoms there are. Supportive care is worth considering only when it is safe for your kidneys and agreed with your kidney team.

Heart and blood vessels

Cardiovascular events are even more common than kidney failure in people with CKD, which is why treatment aims to prevent them.^[2] This is a reason to keep every part of care coordinated.

Itching, fatigue and sleep

Itching, tiredness and poor sleep are common in dialysis patients and are among the symptoms where acupuncture-related treatments have been studied.^[5] Restless legs syndrome is two to three times more common in CKD than in the general population and is linked to insomnia and a lower quality of life.^[3]

Mood and stress

Depression is common in people on dialysis. A Cochrane review found that cognitive behavioral therapy, exercise and relaxation techniques probably reduce depressive symptoms in adults on dialysis, while the evidence for acupressure was of low certainty.^[4]

Acupuncture as supportive care in Chronic Kidney Disease

What the research shows

Acupuncture has not been shown to improve kidney disease itself, and the evidence for symptoms is limited. A Cochrane review of 24 studies with 1,787 adults with stage 3 to 5 CKD found very low-quality evidence that manual acupressure reduced depression, fatigue and sleep problems in people on hemodialysis. The review could say little about other types of acupuncture, because the studies were small and at high or unclear risk of bias.^[5]

A 2024 meta-analysis of 24 studies with 1,494 participants reported lower serum creatinine and less itching with acupuncture than with control treatment, but the authors rated the evidence very low and called for high-quality trials.^[6] Individual small trials point the same way. In one trial of 40 hemodialysis patients with refractory itching, acupuncture at a single point beat acupuncture at a nearby non-point, with benefit lasting at the 3-month follow-up.^[7] In a trial of 72 hemodialysis patients, laser acupuncture (a needle-free version) improved post-dialysis fatigue and sleep compared with an inactive laser, and a small single-blind trial of 41 patients (35 completed it) found acupuncture eased restless legs symptoms.^{[8, 9]}

How acupuncture may work

How acupuncture might help these symptoms is not established. One small restless legs trial found shifts in heart rate variability, a measure linked to the autonomic nervous system, in the acupuncture group, but this does not show why symptoms improved.^[9] These are proposed explanations, not settled facts.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, with a course of several visits and reassessment. The restless legs trial gave 12 sessions over four weeks, and the itching trial gave three sessions a week for a month.^{[7, 9]} Needling is generally avoided in a dialysis fistula or graft arm and in areas of swelling or skin infection.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] The Cochrane review noted that harms were poorly reported in kidney patients.^[5] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in Chronic Kidney Disease

The Ayurvedic view

Ayurveda describes disorders of urine formation under the category of Mutravaha srotas (urine-carrying channels), and reduced kidney function is traditionally discussed as a disturbance of the doshas and of tissue nourishment. These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and, in CKD, is limited. It may include:

• Gentle diet and daily routine advice, such as regular meals and sleep, which must fit your kidney diet (limits on salt, potassium, phosphorus or protein, as set by your kidney team)
• Warm oil massage for comfort, avoiding any fistula or graft arm
• Stress-reducing breathing and relaxation practices

Panchakarma procedures, including medicated enemas, purgation and fasting, are not appropriate in CKD. They can cause fluid and electrolyte shifts, and they are not appropriate during pregnancy, acute illness or frailty.

What the research shows

We found no clinical trials of Ayurvedic treatment for chronic kidney disease in PubMed. Ayurvedic herbs are therefore not presented as a way to treat CKD.

Curcumin, the main compound in turmeric, is the closest studied example. In a placebo-controlled trial of 533 adults with albuminuric CKD, curcumin for six months did not change albuminuria or eGFR.^[11] Diet and nutrient choices matter in CKD and are best set with a renal dietitian.^[2]

Herbal medicine as supportive care in Chronic Kidney Disease

Herbs and formulas that have been studied

Chinese herbal formulas are studied for CKD in China, including blood-activating formulas for kidney scarring and a patent medicine called Niaoduqing granules.^{[12, 13]} Astragalus (huangqi) is one single herb with a recent trial in diabetic kidney disease.^[14]

What the research shows

The evidence is limited, and most trials are small and of low quality. A 2023 meta-analysis of 16 trials with 1,356 participants found that blood-activating Chinese herbal treatment plus standard care improved some kidney scarring markers and creatinine more than standard care alone. The quality of evidence was low to very low, publication bias was likely, and safety was rarely reported.^[12] A 2024 meta-analysis found that traditional Chinese medicine treatment was associated with higher eGFR and lower creatinine than care without it, but its abstract does not rate the certainty of the evidence.^[15]

A 2024 trial in Hong Kong randomized 118 people with diabetic kidney disease to add astragalus or continue standard care alone. The eGFR declined more slowly with astragalus over 48 weeks, but albuminuria did not differ, and the trial was assessor-blinded but had no placebo.^[14] These findings do not mean any herb is safe for your kidneys.

Safety and herb-drug interactions

Herbs are the part of complementary care that carries the most risk in kidney disease. Some herbal products cause kidney toxicity, including those containing aristolochic acid, and reviews note that this can be missed because people assume herbs are harmless. Toxicity can come from the herb itself, contamination, adulteration, heavy metals and interactions with medicines.^[16] Herbs that are harmless to healthy people may be unsafe when the kidneys cannot clear them.

Reviews also document herb-drug interactions, including bleeding with some herbs taken with warfarin or aspirin and reduced levels of immunosuppressants such as ciclosporin with St. John's wort.^[17] About one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[18] Any herb should be reviewed against your latest kidney test results and with your nephrologist's agreement before it is used. Tell us if you are pregnant or breastfeeding. A herbal preparation applied to the skin through transdermal medication therapy has not been studied for CKD, and we make no claim for it.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes kidney disease as deficiency of kidney qi or yin, with dampness or blood stasis. Researchers studying blood-activating formulas look at markers of kidney scarring such as collagen and TGF-beta, and the quality of this research is low.^[12]

In Ayurveda, impaired Mutravaha srotas describes disordered urine flow and tissue nourishment. No study has shown that a dosha or a channel corresponds to a particular biological process, and no Ayurvedic CKD trials were found.

How this care fits with your medical care

CKD needs medical treatment, and our role is supportive. Keep your nephrologist, primary care physician and dialysis team, keep taking your prescribed medicines, and do not stop or change them without your prescriber. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Please bring your diagnosis and stage, your most recent kidney function and potassium results, a full list of medicines and supplements, and details of your diet restrictions and any dialysis schedule or access site.

When to seek urgent medical care

Some symptoms of kidney disease can signal a dangerous complication and need prompt care.^[1]

• Shortness of breath, chest pain, or swelling that is rapidly worsening
• Very little or no urine, or a sudden change in urination
• Confusion, severe drowsiness, seizures or fainting
• Persistent vomiting or inability to keep fluids or medicines down
• Muscle weakness or a very slow or irregular heartbeat, which can signal high potassium
• Fever, redness, pain or drainage at a dialysis access site or catheter

If any of these occur, call 911 or go to the nearest emergency department.