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A Review of Dietary Supplement–Induced Renal Dysfunction

Steven Gabardi^*,,, Kristin Munz^*, and Catherine Ulbricht

^* Department of Pharmacy Services, Renal Division, Brigham and Women's Hospital, Harvard Medical School, and Natural Standard and Department of Pharmacy Services, Massachusetts General Hospital, Boston, Massachusetts

Address correspondence to: Dr. Steven Gabardi, Renal Division/Department of Pharmacy Services, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115-6110. Phone: 617-732-7658; Fax: 617-732-7507; E-mail: sgabardi{at}partners.org

Complementary and alternative medicine (CAM) is a multibillion-dollar industry. Almost half of the American population uses some form of CAM, with many using them in addition to prescription medications. Most patients fail to inform their health care providers of their CAM use, and physicians rarely inquire. Annually, thousands of dietary supplement–induced adverse events are reported to Poison Control Centers nationwide. CAM manufacturers are not responsible for proving safety and efficacy, because the Food and Drug Administration does not regulate them. However, concern exists surrounding the safety of CAM. A literature search using MEDLINE and EMBASE was undertaken to explore the impact of CAM on renal function. English-language studies and case reports were selected for inclusion but were limited to those that consisted of human subjects, both adult and pediatric. This review provides details on dietary supplements that have been associated with renal dysfunction and focuses on 17 dietary supplements that have been associated with direct renal injury, CAM-induced immune-mediated nephrotoxicity, nephrolithiasis, rhabdomyolysis with acute renal injury, and hepatorenal syndrome. It is concluded that it is imperative that use of dietary supplements be monitored closely in all patients. Health care practitioners must take an active role in identifying patients who are using CAM and provide appropriate patient education.