Renal transplant recipients who rely on CAM are less likely to follow doctors’ orders, study finds.

TORONTO—Kidney transplant patients who use complementary and alternative medicine (CAM) are less likely than others to adhere to their prescribed drug regimens, according to study findings presented here at the 2008 American Transplant Congress.

Mariana Markell, MD, a transplant nephrologist and associate professor of medicine at the State University of New York Downstate Medical Center, Brooklyn, N.Y., and her colleagues surveyed 51 randomly selected kidney transplant recipients. Most were black, and just over half were female. Subjects had an average age of 47.8 years.

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Of 23 patients who reported using some form of CAM, 19 had not mentioned this to their health-care team. The most common forms of CAM were relaxation and guided imagery, massage, special foods or special diets, and herbs and other supplements.

Use of CAM by patients was associated with nonadherence to immunosuppressive, antidiabetes, and cholesterol-lowering medications. CAM users believe that doctors place too much trust in medications and that natural remedies are safer than pharmaceutical products. They did not believe that following doctors’ orders is the best way to stay healthy or that health depends on non-CAM medicines.

According to the investigators, the study results pose a dilemma for nephrologists: how to approach patients who are likely to distrust them and not follow their treatment suggestions. The answer, Dr. Markell said, is to be respectful.

“One has to be careful not to become paternalistic and condemn CAM, as that will make the patient even less likely to reveal use,” said Dr. Markell, who wrote a paper on the potential benefits of complementary medicine in CKD patients (Adv Chronic Kidney Dis. 2005;12:292-299). “I personally have no problem approving of modalities that I know will not harm patients and steering them away from clearly harmful ones.”

Michelle Josephson, MD, a nephrologist and professor of medicine at the University of Chicago, said transplant physicians “should let the patient know it is safe to discuss [CAM use] with us and that we will advise them honestly and nonjudgmentally.”

It is incumbent on transplant physicians to learn about CAM or have resources available so they can find out if, for example, specific therapies are safe, what their side effects may be, what drug-drug interactions might occur, and whether they have immunologic consequences, Dr. Josephson said.