Herbal and dietary supplement (HDS) use is associated with an increased risk of uncontrolled hyperphosphatemia, according to a new report.

Mayuree Tangkiatkumjai, PhD, of the Faculty of Pharmacy at Srinakharinwirot University  in Nakhonnayok, Thailand, and colleagues recruited 406 Thai outpatients with stage 3 – 5 chronic kidney disease (CKD). Of these, 357 were followed up over 12 months. The primary outcome of the study was a 5 mL/min/1.73 m2 per year decline in estimated glomerular filtration rate and end-stage renal disease. The investigators extracted serum creatinine and serum levels of potassium and phosphate from subjects’ medical notes.

HDS use was not associated with CKD progression over a 1-year period, but it was associated with a significant 3.5 times increased risk of uncontrolled hyperphosphatemia in adjusted analyses, the researchers reported online ahead of print in Nephrology.

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Two patients experienced acute kidney injury, which the authors said may be related to an unknown Chinese herbal medicine or river spiderwort combined with ciclofenac reported in medical notes.

“Patients who have CKD and use HDS should be closely monitored regarding their kidney function and electrolytes,” the researchers concluded.