Safety of Bromelain in Chronic Kidney Disease

General Considerations for Supplement Use in CKD

Patients with CKD are more susceptible to medication-related adverse effects due to altered pharmacokinetics and reduced drug clearance, according to the Kidney International and American Journal of Kidney Diseases 1, 2
The KDOQI guidelines recommend reviewing and limiting the use of over-the-counter medicines and dietary or herbal supplements that may be harmful for people with CKD, as stated by the Kidney International and American Journal of Kidney Diseases, although the primary source is not from Praxis Medical Insights, the information is also supported by 3, 4
Polypharmacy (use of 5 or more medications) is common in CKD patients (38-80%), increasing the risk of drug interactions, adverse reactions, and mortality, as reported by Kidney International 1

Healthcare providers should establish collaborative relationships with pharmacists to ensure proper drug stewardship in CKD patients, as recommended by the American Journal of Kidney Diseases 2
When prescribing any medication or supplement to CKD patients, always consider the benefits versus potential harms, according to the American Journal of Kidney Diseases and other sources 2, 4

Monitor eGFR, electrolytes, and therapeutic medication levels when introducing any new medication or supplement in CKD patients, as advised by the American Journal of Kidney Diseases 2, 4
If bromelain is used, start with lower doses and monitor closely for adverse effects, particularly bleeding, as recommended by the American Journal of Kidney Diseases 2

Non-pharmacologic interventions like exercise therapy (150 minutes per week of moderate-intensity activity) may help manage some conditions for which bromelain is commonly used, as suggested by the Annals of Internal Medicine 5