Prospective Analysis of Self Medication With Phytotherapy in Nephropatic Patients.

Overview

We propose the following hypotheses: * The use of herbal medicine is common among patients with chronic kidney disease in Réunion island. * This use could influence the progression of kidney disease in these patients. To assess the primary inclusion criterion, patients will be easily identified by nephrologists through existing follow-up. The questionnaires will be administered after this early identification by the investigators at each center. The primary evaluation criterion is straightforward: it aims to establish an overview of the use of herbal medicine in our patient population. This information is currently unavailable and remains crucial for measuring the extent of the issue. Our secondary criteria will involve more in-depth analysis of this use and an attempt to correlate the use of certain herbs with the rate of progression of kidney disease at one year. We targeted patients with moderate to end-stage chronic kidney disease (KDIGO classification 3 to 5), which are the stages typically included in kidney disease studies. Furthermore, these patients are the most likely to experience a greater annual progression of their kidney disease, and the effect of herbs on this progression could be investigated. Transplant patients were not included because they are more aware of the risks of not using herbal medicine due to their use of immunosuppressants.

The use of traditional medicine is widespread globally. In Africa, the prevalence is estimated at 60%, while usage in developing countries may reach 80%. Phytotherapy is defined as the treatment or prevention of diseases using plants; it plays a role in both traditional medicine and the current "modern" market. Chronic kidney disease (CKD) is one of the most common chronic conditions worldwide, with over 800 million prevalent cases. Its prevalence is steadily rising, affecting high-income and low-to-middle-income countries alike. Patients with kidney disease may be heavily exposed to phytotherapy. Phytotherapy has long been used to treat kidney disease, and the kidneys are a primary route for the elimination of plant-derived compounds and their metabolites. While some plants appear to possess nephroprotective properties, others may cause acute kidney injury, chronic kidney disease, kidney stones, Fanconi syndrome, or urothelial cancers. Patients with chronic kidney disease may be at particular risk of nephrotoxicity due to reduced nephron mass and polypharmacy. Currently, there is very little data regarding the use of phytotherapy among patients with chronic kidney disease, or concerning its protective or toxic effects. In Réunion, there is a strong culture of phytotherapy-known as \*z'herbages\* in Réunionese Creole. Réunion is also the French department with the highest prevalence of end-stage renal disease. Patients with chronic kidney disease in Réunion may frequently use phytotherapies-whether for renal or systemic purposes-the consequences of which remain unknown. There is therefore a clear need to map these practices in order to identify candidate plants with potential nephroprotective or nephrotoxic effects.