Implementation of alternative therapy practices does not influence dietary compliance in chronic kidney disease: a cross-sectional study

Abstract Background and Aims Implementation of alternative therapies is a common practice in patients with chronic disease. Frequency in different countries is varying, highly dependant on local cultural habits. Furthermore, alternative therapy, especially if taken seriously, might be associated with reduced compliance to conventional interventions. Chronic Kidney disease (CKD) is a progressive chronic illness with a really high mortality, which ends up with renal replacement treatment. In CKD certain dietary restrictions are central part of conventional treatment. The scope of the presented study was to determine prevalence of self implementation of alternative therapies and its relationship with compliance to dietary restrictions in CKD patients in Greece. Respective epidemiological data are still totally missing. Method Consecutive patients of the Outpatient Nephrology Wards and all patients of the Peritoneal Dialysis (PD) and Haemodialysis (HD) Units of the University Hospital of Larissa, the General Hospital of Veria and the University Hospital Attikon in Athens (Greece) were studied after informed consent from June to December 2019. The international Complementary and Alternative Medicine questionnaire (I-CAM-Q), was applied. The questionnaire registers all visits to complementary or alternative health-care providers, the respective treatments, the use of herbals, of dietary supplements, and self-help practices. Patients’ 24h recollection data were used to calculate dietary intake of protein, sodium, potassium and phosphorus. Albumin, phosphate, sodium, potassium, creatinine and urea were determined with routine methods in the central Laboratory of the University Hospital of Larissa. Results Overall 261 patients (165 males, aged 66.1±13 years) witk CKD were included. Among them102 were on chronic haemodialysis and 59 on peritoneal dialysis treatment. The prevalence of alternative treatment practices was overall 45%, significantly higher in female patients (OR 1,494, ci 1,085-2,057, P = .015). The frequency in PD patients and in CKD patients was significantly higher than in HD patients (PD 69.5%, CKD 55% and HD 21.6%; p<0.01). There was no significant variation due to profession or education. The prayers and confession (31.1%) as well as the use of herbs (25.3%) were the most frequent alternative practices applied. In HD prayers (prevalence 8.9%) and the use of herbs (8.9%) are less frequently practiced than in the other groups. The dietary compliance was for phosporus about 24% and when all relevant diet parameters were considered 18%. Compliance to dietary restrictions was better in females (P = .024) but was independent of the patient's profession (P = .42) and educational status (P = .89). No significant influence of the alternative treatment practices application was determined on the compliance to diet of either CKD, PD or HD patients. Conclusion The autonomous implementation of alternative medical and other treatment and self-help practices is common among patients with CKD with a predominace of females. In Greece the most commonly applied practices are herbs and prayers or the confession. There is overall a lower prevalence of alternative practices n HD patients than CKD and PD patients. The initial hypothesis, namely that alternative therapy implementation might combine with reduced compliance of patients to conventional interventions was not confirmed at least as far as the dietary restrictions prescrıbed for CKD patients are concerned. The role alternative treatment practices in CKD and its relationship to the patients’ physical and mental health deserves further investigation.