In the United States, the supplement industry makes roughly $60 billion per year, and it is estimated that there are more than 100,000 supplements available in the market today. All of which are not regulated by the FDA or any other governing body. With numbers like that, it can be hard for healthcare professionals to stay abreast of what’s trending, what the research says, and how to apply or avoid use in practice.

In research specific to chronic kidney disease (CKD), studies have found a range of supplement use anywhere from 9% of patients to 90% of patients.
And, typically, research agrees that in patients who are using alternative medicines like herbal products, more than 60% of them are not discussing use
with their healthcare providers.

So how do we address this problem when working with dialysis patients? Read on for tips and ideas.

Always Ask
With more than 60% of patients not reporting the use of alternative therapies to care providers, the number one thing we can do to get a handle
on the situation is to ask direct questions related to use of supplements.

  • Are you taking any pills, gummies, tinctures, or syrups that have not been prescribed by your doctor?
  • Are you using herbal supplements? This can include pills or drinks intended to boost your immune function, relieve constipation, etc.

Once you have identified a patient using an herbal supplement, the questions should shift to open-ended prompts that encourage discussion.

  • Why did you start taking this supplement?
  • How long have you been using the supplement?
  • What changes/improvements/effects have you noticed since taking the supplement?
  • What dose and form of the supplement are you using?

Use Information Available to You
Since it is unlikely that you will be able to memorize information regarding more than 100,000 supplements that are estimated to be on the market today,
it means you will need to research supplements on a case-by-case basis and of course document the research you do so it is available later.

The research on supplements in CKD is limited. In a literature review of 49 different supplements, only 14 turned up with CKD-related research and much of that was specific to a subtype (i.e., diabetic kidney disease or autosomal polycystic kidney disease) or as a cause of kidney injury (i.e. red yeast rice).
In this instance, a dietitian looking for answers will have to combine the best available evidence, like research that is not specific to CKD, combined
with their clinical expertise.

A conservative approach will likely mean directing patients away from herbal products and supplements and towards other diet or lifestyle changes
with evidence to support them. Leveraging the knowledge gained through discussion with the patient, you will likely be able to find opportunities
for change.

For example, many patients report using herbal products to alleviate common symptoms like constipation. Someone might think drinking aloe vera juice
or cascara sagrada is the solution, but the dietitian can offer many alternatives including:

  • Increasing dietary fiber
  • Prioritizing high- protein foods that are also easy to digest
  • Introducing a probiotic supplement
  • Increasing physical activity
  • Adjusting oral iron supplements (if taking) to options that are less likely to cause constipation

Be Persistent and Reliable
Your patients will be bombarded with messages about supplements nearly everywhere they go, whether it is in person or online. That means you also need to be a consistent presence in your patient’s life.

  • Follow up regularly and help track progress of any agreed upon changes
  • Reinforce education you have provided on topics relating to supplement safety, symptom management, and benefits of diet and lifestyle changes
  • Recruit the interdisciplinary team to help keep patients on track
  • Be available to answer new questions as they come up and encourage open communication

For more resources on helping patients navigate supplement use, join our monthly webinar and find patient focused supplement handouts
on the Clinician Portal.

References

    • Chin, J. W., Abdullah, R., Tan, B. W. W., Wong, K. W., & Khor, B. H. (2025). Prevalence and patterns of complementary and alternative medicine usage among adults with chronic kidney disease: A systematic review and meta-analysis. Journal of Integrative Medicine.
    • Dores, A. R., Peixoto, M., Castro, M., Sa, C., Carvalho, I. P., Martins, A., … & Marques, A. (2023). Knowledge and beliefs about herb/supplement consumption and herb/supplement–drug interactions among the general population, including healthcare professionals and pharmacists:
      A systematic review and guidelines for a smart decision system. Nutrients, 15(10), 2298.
    • Raffoul, A., Santoso, M., Lu, J., Duran, V., & Austin, S. B. (2024). Diet pills and deception: A content analysis of weight-loss, muscle-building,
      and cleanse and detox supplements videos on TikTok. Eating Behaviors, 55, 101911.

 

We thank our guest blogger Maiya Slusser, MS, RDN, CD, CNSC, Director, Research and Education for sharing her knowledge and writing this blog post!