Usage of complementary and alternative medicine among patients with chronic kidney disease on maintenance hemodialysis

摘要

Aim: To determine the prevalence and the type of complementary and alternative medicine (CAM) use among chronic kidney disease (CKD) patients on maintenance hemodialysis (MHD). Materials and Methods: The study was conducted in 200 CKD patients who were on MHD. The patients were subjected to a validated interviewer-administered questionnaire adopted from the National Health Interview Survey Adult CAM. The knowledge on CAM and its usage by the patients were assessed based on the responses given by the patients. Results: Of the 200 patients, 52 (26%) patients were identified to be using CAM therapy. The most commonly used CAM modality by these patients was Ayurveda both alone (30.4%) and in combination with other CAM modalities (23.2%), followed by acupuncture in 17.3% patients. CAM usage was high in the age range of 50–64 years (67%). Of the CAM users, 21% of patients were from a rural area; 16.5% of patients were from upper middle class, and 24% were on dialysis for 1–4 years. There was a statistically significant association between CAM usage and age, gender, place of living, socioeconomic status, and duration of dialysis ( P th Century A.D. It focuses on a customized treatment based on the individual using practices such as yoga, meditation, massage, diet, and herbs. Naturopathy A philosophy that utilizes noninvasive treatments to help the body heal itself. Practices utilized include massage, herbal remedies, exercise, and lifestyle counseling. Ancient medicine These included Chinese, Asian, Pacific Islander, and American Indian and Tibetan practices. Chinese medicine, for example, includes treatments such as acupuncture, qigong, herbal medicine, exercise, and breathing techniques. Mind-body interventions Mind-body medicine works to use the mind to affect the body and its physical symptoms. The premise is that the mind and body must be in harmony to stay healthy. Examples include psychotherapy, guided imagery, meditation, prayer and mental healing, hypnosis, dance, music, and art therapy. Some mind-body practices systems that were once considered CAM are now in mainstream including support groups and cognitive-behavioral therapy. Biologically based treatments These treatments utilize natural but unproven products such as herbs, minerals, and hormones to promote health. Examples include specialized diets (e.g., macrobiotics), dietary supplements, and herbal therapies. However, many of these treatments are scientifically unproven, and can be harmful, particularly from interactions with other medication. Manipulative and body-based methods These practices are based on manipulation: “The application of controlled force to a joint, moving it beyond the normal range of motion in an effort to aid in restoring health.” Examples include chiropractic care, osteopathic manipulation, massage therapy, pressure point therapies, rolfing, polarity therapy, and craniosacral therapy.[ 5 ] Energy therapies Energy medicine practitioners believe an invisible energy force flows through the body. When this force becomes blocked or unbalanced, it manifests physical illness. This force has been referred to as Chi, Prana, and the life force. The goal of these therapies is to correct this blockage. The field is divided into two areas: Biofield and bioelectromagnetic-based therapy. Biofield therapies, work to “affect the energy fields that purportedly surround and penetrate the human body through applying pressure or manipulating the body by placing the hands in or through these fields.” Examples include Qigong, Reiki, and therapeutic touch therapy. Bioelectromagnetic therapies utilize magnetic, pulsed, or direct current fields for healing.[ 4 ] Though patients with CKD turn to CAM for controlling the symptoms and coping with the disease to combat the chronic nature of the disease and the potential threat posed by renal failure on QOL, the data on the use of CAM among CKD patients remain insufficient.[ 6 , 7 , 8 ] The reason for this is to some extent, the usage of CAM modalities by the CKD patients without the knowledge of the health care team.[ 9 ] Studies that have examined the prevalence of CAM use in patients with CKD revealed that 18% of dialysis patients had used or were using some form of alternative medicine and an additional 63% of patients were willing to use CAM.[ 10 ] A regular usage of CAM was reported by 57% of dialysis patients and 49% of transplant patients in another study.[ 11 ] In Turkey, 68.8% of the HD patients have insufficient knowledge of CAM even though 49.4% of them were using CAM.[ 12 ] The health care team should play a vital role in identifying CAM use among their patients, the adverse effects of CAM and its possible complications. They should be aware of educational needs of their patients and be prepared for open communication regarding CAM by initiating open discussions and questioning the patients about the use of these products. In order to achieve this, a thorough knowledge of CAM modalities