Ayurvedic management of chronic kidney disease: A case report

INTRODUCTION

Chronic kidney disease (CKD) is identified by persistent kidney damage or a sustained estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m² for at least 3 months, regardless of the underlying cause. It is a progressive condition that leads to a gradual decline in kidney function, often necessitating renal replacement therapies like dialysis or transplantation. Kidney damage can be indicated by structural abnormalities detected through imaging or biopsy, changes in urinary sediment, or elevated urinary albumin excretion. The 2012 Kidney Disease Improving Global Outcomes (KDIGO) classification system recommends identifying the specific cause of CKD and categorizes it into six stages based on GFR levels (G1 to G5, with G3 further divided into 3a and 3b). Published studies reported that diabetes mellitus (DM) and hypertension (HTN) are responsible for more than two-thirds of CKD cases. Additionally, environmental influences such as lead exposure, smoking, metabolic syndrome, prolonged use of NSAIDs, and obesity have been associated with a rapid decline in kidney function. CKD is associated with disturbances in fluid and electrolyte balance, metabolic acidosis, anemia, cardiovascular complications, gastrointestinal, endocrine, metabolic irregularities, and nutritional disturbances.

The clinical presentation of CKD is similar to the disease entity, Vrikka Vikara, described in the Ayurveda classical text, Bhaishajya Ratnavali. Additionally, the management principles described for Shotha (swelling/inflammation in tissues) and Mutraghata (disease condition presenting with urinary retention or low urine output) in Ayurveda can also be applied to manage CKD based on the clinical presentation.

The present case report highlights the therapeutic benefits of individualized Ayurvedic management in CKD, such as improving renal function and better quality of life.

CASE REPORT

A female aged 48 years presented to the Kayachikitsa OPD of a Government Ayurveda Hospital in New Delhi on October 8, 2024, with complaints of swelling over the face and feet for 2 years, itching all over the body, and pain in the lower back for the past 6 months. She had neither prior history of systemic illnesses such as hypertension, diabetes mellitus, cardiovascular disorders, thyroid dysfunction, nor any family history of these disease conditions. She had been self-medicating with over-the-counter NSAIDs for knee osteoarthritis for approximately 6-7 years without medical supervision. Over time, she experienced persistent weakness and sought medical consultation from a private practitioner in August 2021, where she was advised to undergo routine blood investigations and ultrasonography (KUB region). Based on the laboratory findings, she was diagnosed with G-2 CKD. She subsequently began conventional treatment, but despite this, her renal function progressively deteriorated from CKD G-2 to Grade-5. Eventually, she was advised to initiate dialysis or consider renal transplantation. Hoping to delay or avoid dialysis, the patient discontinued her ongoing conventional treatment and visited the above-said Ayurveda hospital and consented to Ayurveda management for her clinical condition.

RESULTS

During treatment, the patient’s kidney function improved from Grade 5 (end-stage kidney disease) to Grade 2 (mild to moderate kidney dysfunction). Further, marked improvement was observed in e-GFR, serum creatinine, and blood urea, along with the absence of proteinuria and an increase in hemoglobin concentration as described in Table 3 and Figure 1. Also, there was significant relief in low back ache, pedal edema, nausea, generalized weakness, and constipation with improved appetite and sleep (Supplementary Table 2). Moreover, no adverse events were reported by the patient during the study period.

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Figure 1:

Kidney function at different timepoints.

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DISCUSSION

The outcomes of this case report suggest that Ayurveda interventions may contribute positively to kidney function and overall health. Ayurveda management of CKD is based on the treatment principles of Vrikka Vikara (kidney disorders), Shotha (generalized swelling), Mutraghata (urinary obstruction), and Paṇḍu (anemia), as described in Ayurveda classical texts. As per Ayurveda principles, Kapha Dosha is primarily involved in the pathogenesis of CKD, obstructing the microchannels (leading to microangiopathy), whereas Vata Dosha is primarily responsible for the degeneration and structural deterioration of the kidney tissue.¹ Lekhana (scraping) therapies are incorporated to address the Kapha-mediated obstruction to clear the blocked microchannels and restore the flow within the microcirculation to prevent further tissue damage. According to Ayurveda principles, ensuring Vatanulomana (regulation of Vata Dosha) is critical for maintaining normal renal functions. In addition, Rasayana therapy is pivotal in strengthening and rejuvenating the affected tissues in chronic disease conditions, enhancing their resilience. Thus, the comprehensive Ayurvedic management of CKD includes Vatanulomana, Lekhana, Rasayana Chikitsa, along with disease-specific approaches drawn from the Ayurveda management principles of Vrikka Vikara, Shotha, Mutraghata, and Paṇḍu. This multidimensional approach not only targets alleviation of symptoms but also focuses on halting disease progression and promoting tissue regeneration. Ayurveda interventions prescribed in this case study include Sarvatobhadra Vati, Punarnava Mandoora, Trinapanchamula Kwatha, Gokshuradi Guggulu, Chandraprabha Vati, Shweta Parpati, and Bakayana Swarasa.

The ingredients of Sarvatobhadra Vati, an Ayurvedic metallo-mineral formulation, have Rasayana (rejuvenative), adaptogenic, and immunomodulatory effects, thereby enhancing systemic strength, vitality, and tissue regeneration.² The formulation is prepared through triturating with the decoction of Varuna (Crataeva nurvala), a medicinal plant widely acknowledged for its renoprotective, antioxidant, and diuretic properties, thereby mitigating oxidative stress-induced renal damage and further augmenting the kidney-supportive and detoxifying potential of the formulation.³ These ingredients may work synergistically to support renal function, prevent nephrotoxic damage, and promote overall physiological rejuvenation. Although this medicine contains heavy metals, preliminary evidence suggests its safety.⁴ Punarnava Mandoora is an Ayurvedic formulation commonly employed in treating Pandu Roga (anemia), a condition frequently observed as a significant clinical manifestation in CKD. It primarily contains Punarnava (Boerhavia diffusa L.), which is known for its renal regenerative effects, supporting kidney function, and reducing fluid retention levels. Published studies have reported the efficacy of Punarnava in reducing serum creatinine and urea levels while enhancing overall renal function.⁵ The formulation aligns with the Ayurvedic principles of Mutravaha Srotas Shodhana (cleansing the urinary system) and Shothahara Chikitsa (anti-inflammatory action) in the CKD management, making it a valuable adjunct and also contributing to managing associated anemia and edema in CKD. Trinapanchmoola Kwatha, an herbal decoction, helps eliminate excess fluids and toxins from the body while maintaining the balance of electrolytes and supporting optimal kidney function.⁶ Gokshuradi Guggulu is an Ayurveda formulation that contains Gokshura, which has diuretic and rejuvenating effects, aids in alleviating burning micturition, and helps repair tissue damage in the urinary tract through its antioxidant properties.⁷ Whereas Guggulu has anti-inflammatory and cleansing properties that assist in clearing blockages in the urinary system, reducing swelling, and managing oliguria. The diuretic potential of Chandraprabha Vati has been demonstrated through experimental studies, suggesting its efficacy in alleviating edema by promoting the elimination of excess fluid and reducing water retention. Due to its alkalizing properties, Sweta Parpati is indicated in Ayurveda classical texts to relieve burning sensation during micturition and dysuria present in various urinary disorders. The therapeutic potential of oral alkalizing agents in supporting renal function and minimizing the risk of metabolic acidosis is well-documented, especially in patients with CKD.⁸ Bakayana Swarasa (juice of Melia Azedarach bark), due to its Deepana-Pachana (improve metabolism), Lekhana (remove toxic by-products of metabolism and improve microcirculation), and Shodhana (biopurification) properties, is recommended to alleviate the pathogenesis of CKD. A few case reports have also reported its promising effect on the clinical outcomes of CKD.⁹ In the present study, food items prepared from millet were also recommended for the routine diet. Barnyard, Kodo, and Browntop millets are rich sources of iron, calcium, and dietary fibers that may play a crucial role in managing common complications of CKD, such as anemia, hypocalcemia, and constipation. Further, the preliminary evidence suggests that Foxtail millet demonstrates a significant protective effect against kidney tissue damage.¹⁰

CONCLUSION

The present case study highlights the promising outcomes of the Ayurveda therapeutic regimen in managing CKD in terms of significant improvement in the clinical and laboratory parameters. However, well-designed randomized controlled trials (RCTs) with suitable intervention and follow-up periods are needed to further substantiate the efficacy of Ayurvedic interventions in restoring renal function and enhancing overall health in subjects with CKD.