FUTURE TRENDS IN RENAL NURSING:

HERBAL REMEDIES

NAME: SITI HAJAR BINTI AZIZ

MATRIX NO: SD01-201811-003109

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 ABSTRACT

Article one

The primary aim of this study was to evaluate the use of CAM among patients with end-
stage renal disease (ESRD) who are undergoing HD.

Article two

The review aims to provide knowledge and guide to encourage future toxicity studies on
the kidney by medicinal herbs.

INTRODUCTION

I had chosen both of the articles because complementary and alternative medicine
(CAM), and herbal therapies, are accepted worldwide and have been important from
medical, sociological and economic perspectives, among haemodialysis (HD) patients.
However, available herbal products have no clear statement of content or medically
related information on the package labels and have not been validated or certified by
any recognized body. It is very interesting topic to review because it provides knowledge
and guidance to encourage future toxicity studies on the kidney by medicinal herbs and
it will help health care providers aware of the potential benefits and risks related to CAM
use.

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 STATEMENT OF THE PROBLEM

Article one

Despite the ubiquitous use of CAM at a global level in a broad range of illnesses or
populations, there is limited data concerning the use of CAM or herbal therapies in
patients with ESRD. An extensive search did not reveal information concerning the use
of CAM or herbal among HD patients in the Arab Middle East where medicinal herbs, or
some types of CAM such as honey, prayers, fasting, or exorcism in Islam are an integral
part of the culture and religion.

Article two

Many problems in primary healthcare are due to lack of knowledge and sensitivity to
local health practices, and due to the economic and cultural factors associated with
these practices. However, available herbal products have no clear statement of content
or medically related information on the package labels, and have not been validated or
certified by any recognized body. This concerns consumers and medical practitioners
who may unknowingly counter-prescribe these herbal products.

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 PURPOSE OF THE STUDY

Article one

This study was performed to determine the prevalence and types of CAM and herbal
therapies used among Palestinian patients with HD. It also aim to contribute to this
growing area of research by helping in plan the interventions needed to improve the
self-use of CAM or herbal therapies, and by identifying the most commonly used CAM
or herbal therapies which may form a data-base for further research.

Article two

The goal of this study is the toxic and beneficial effects of medicinal herbs on renal
health by which evidence for benefit or toxicity has been found.

RESEARCH QUESTIONS

Article one

Use of CAM or herbal remedies among Palestinian people and Arab or Muslim
populations in general is driven by culture, history, sometimes religion, and sometimes
by herbalists spread all over the country rather by advice from healthcare providers.
Based on this, the investigators did address the question “who recommends these
herbs to HD patients” because of the many possible confounding factors.

Article two

There is no research question found in article two.

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 THEORETICAL FRAMEWORK

There has been no theoretical framework found in both articles.

LITERATURE REVIEW

Article one

Title: Safety of Traditional Arab Herbal Medicine

Herbal remedies are widely used for the treatment and prevention of various diseases
and often contain highly active pharmacological compounds. Many medicinal herbs and
pharmaceutical drugs are therapeutic at one dose and toxic at another. Toxicity related
to traditional medicines is becoming more widely recognized as these remedies become
popular in the Mediterranean region as well as worldwide. This article presents a
systematic review on safety of traditional Arab medicine and the contribution of Arab
scholars to toxicology. Use of modern cell biological, biochemical, in vitro and in vivo
techniques for the evaluation of medicinal plants safety is also discussed.

Reference:
Saad B, Azaizeh H, Abu-Hijleh G, Said O. Safety of traditional arab herbal medicine.
Evid Based Complement Alternat Med. 2006;3(4):433–9. doi: 10.1093/ecam/nel058.

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Article two

Title: Medicinal herbal extracts -- renal friend or foe? Part one: the toxicities of
medicinal herbs.

In recent years, an increasing percentage of people from industrialized countries have

been using complementary and alternative medicines (CAM). This, combined with
numerous warnings regarding the potential toxicity of these therapies, suggests the
need for practitioners to keep abreast of the reported incidence of renal toxicity caused
by the ingestion of medicinal herbs. The goal of the present two-part series, on the toxic
or beneficial effects of medicinal herbs on renal health, is to provide practitioners with a
summary of the most recent information as well as the means by which evidence for
benefit or toxicity has been found. In this first article, we explore in vivo evidence of
toxicity. The review aims to provide a guide to encourage future toxicity studies and
rigorous clinical trials.

Reference:
Wojcikowski K, Johnson D, Gobe G. Medicinal herbal extracts–renal friend or foe? Part
one: The toxicities of medicinal herbs. Nephrology. 2004;9:313–8.

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 METHODS

Article one

Face-to-face interviews of 267 patients with ESRD undergoing HD from ten outpatient
renal departments at a national level in Palestine were conducted from June 2014 to
January 2015. A survey questionnaire, which included questions on socio-demographic
and clinical characteristics, and on the CAM therapies that were used, was
administered.

Article two

Literature search on herbs and the dialysis patient was performed.

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 ANALYSIS

Article one

Despite the ubiquitous use of CAM at a global level in a broad range of illnesses or
populations, there is limited data concerning the use of CAM or herbal therapies in
patients with ESRD. Understanding patterns of CAM therapies used in HD patients will
not only help healthcare providers to provide more informed clinical care but also assist
policymakers in creating the appropriate frameworks for future policy and direct and
encourage researchers to conduct clinical research pertaining to CAM to reach stronger
evidence regarding potential benefits and risks related to CAM use.

Article two

Available herbal products have no clear statement of content or medically related

information on the package labels, and have not been validated or certified by any
recognized body. There is reported nephrotoxicity caused by specific medicinal herbs.
One of the dangers with any combination of medicinal substances is the potential
interaction between the herbs and drug. Adulteration of herbal preparations may cause
significant problems especially in children. For the treatment of chronic kidney diseases,
diet is an important part of the treatment.

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 RESULTS

Article one

Out of 267 patients interviewed, 172 patients used at least one or more type of CAM
therapy. Of the patients who used CAM, herbal therapies were used most often,
followed by honey, diet, and exorcism in Islam. A total of 20 different herbal therapies
were reported by HD patients. The herbal therapies mentioned most often were Nigella
sativa L., Salvia officinalis L., and Pimpinella anisum L.

Article two

The herbs are reported regarding renal toxicity if there is in vivo evidence of toxicity in
animals or humans. The herbs also defined as potentially beneficial to the kidneys if
there is strong in vivo evidence of renal protection from toxic substances or drugs. The
mostly renal toxicity caused by unadulterated medicinal herbs is aristolochic acid (AA)
nephropathy. One of the dangers with any combination of medicinal substances is the
potential interaction between the herbs and drug.

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 DISCUSSION

Article one

Use of CAM or herbal remedies among Palestinian people and Arab or Muslim
populations in general is driven by culture, history, religion, and sometimes by herbalists
spread all over the country rather by advice from healthcare providers. Herbal remedies
usually considered intrinsically safe and beneficial, and are frequently consumed in
large quantities by ESRD patients. The use of herbal medicines in HD patients seems to
bear more risk compared to the general population mainly due to accumulation of toxic
material of herbal remedies in patients with kidney malfunction. Herb-drug interactions
may often be unobserved because healthcare providers are not well-informed about
potential herbal-drug interactions occurring in HD patients.

Article two

Some herbal therapies may be causes of renal toxicity caused by the ingestion of herbs.
Available herbal products have no clear statement of content or medically related
information on the package labels, and have not been validated or certified by any
recognized body. The herbal treatments for complications caused by dialysis and
chronic renal failure and any use of medicinal herbs may be inappropriate for the renal
patient. One of the dangers with any combination of medicinal substances is the
potential interaction between the herbs and drug. Adulteration of herbal preparations
appears to be more common or may cause significant problems, especially in children.
This review reported evidences of nephrotoxicities of many herbs or herbal products,
inorganic and heavy metals that affect nephron activity.

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 LIMITATIONS

Article one

Data in this study was obtained from a cross-sectional study carried out during the
period: June 2014 to January 2015.

Article two

There is no time framework has been mention to conduct this study.

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 CONCLUSION

Article one

The prevalence of CAM is relatively high in the selected population. Most patients used
biologically-based therapies such as herbal remedies, thus highlighting a greater need
for patient education regarding CAM therapies and their possible herb-drug interactions.
Health care providers must be aware of the potential benefits and risks related to CAM
use. There is a need for more clinical research pertaining to CAM to reach stronger
evidence regarding potential benefits and risks related to CAM use.

Article two

Some herbal medicine may exert renal toxicity through their inherent properties. If it
found to have some degree of toxicity, the risks can be weighed against the benefits
and decisions can be made regarding their continued availability. Importantly, the
inherent properties of the herb are not the only source of herb-associated renal
disorders, as herb-drug interactions, mistakes in dosage and identification, and
contaminants within the mixture are all issues of concern. Strict controls on the
presence of adulterants within herbal medicines, labeling of dosages and
contraindications, and manufacturing techniques must be maintained to ensure the
safety of those consuming herbal medicines.

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 SUMMARY

CAM and herbal therapies may provide new therapeutic opportunities for HD
patients with the target of enhancing quality of life and improving symptoms.
Conversely, herbal remedies used by HD patients may have numerous possible
benefits such as decreasing muscle cramps. Mind–body medicine, such as
relaxation, or exorcism often involves inexpensive self-care–based actions and
appears to have minimal side effects, risks, or interactions with conventional
treatment. Healthcare providers need to be fully aware of the commonly used
CAM therapies in their culture, and provide the correct information about the
benefits or risks related to CAM therapies that may be used by HD patients.
Healthcare providers also need to identify patients who should be given focused
education about the potential benefits and risks of herbal therapies. A diet rich in
fruits and vegetables significantly reduces the risk of kidney toxicity. For the
treatment of chronic kidney diseases, diet is an important part of the treatment.
The recommended diet may change over time if kidney disease gets worse.
Generally there is no need to limit the amount of fluids drunk in the earlier stages
of kidney disease. If kidney disease gets worse, one needs to limit fluids.

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 REFERENCE

1. Asif, M. (2012). A brief study of toxic effects of some medicinal herbs on kidney.
Advanced Biomedical Research , 1-7.

2. Zyoud, S. H., Al-Jabi, S. W., Sweileh, W. M., Tabeeb, G. H., Ayaseh, N. A.,
Sawafta, M. N., et al. (2016). Use of complementary and alternative medicines in
haemodialysis patients: a cross-sectional study from Palestine. BioMed Central ,
1-14.

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