Evaluation of Rhubarb Supplementation in Stages 3 and 4 of Chronic Kidney Disease: A Randomized Clinical Trial

Objective. To evaluate the efficacy and safety of Rhubarb supplementation in patients of chronic kidney disease. Material and Methods. This study was a prospective comparative study conducted in patients of chronic kidney disease (stages 3 & 4) attending Renal Clinic of Department of Medicine, JN Medical College & Hospital, AMU, Aligarh. Patients were randomly divided into two interventional groups. Group I (Control) was given conservative management while Group II (Rhubarb) received conservative management along with Rhubarb capsule (350？mg, thrice daily) for 12 weeks. Haemogram and renal function tests were measured at 0, 4, 8, and 12 weeks of treatment. Results. There was progressive improvement in clinical features in both the groups after 12 weeks of treatment but Rhubarb group showed more marked improvement as compared to control group. Both groups showed gradual improvement in the biochemical parameters as compared to their pretreated values which was more marked in Rhubarb supplemented group. There was reduction in blood glucose, blood urea, serum creatinine, and 24 hour total urine protein (TUP). There was increase in haemoglobin, 24 hour total urine volume (TUV), and glomerular filtration rate (GFR). There was no statistical difference in two groups with respect to side effects . Conclusion. Rhubarb supplementation improved the therapeutic effect of conservative management in stage 3 and stage 4 patients of chronic kidney disease. 1. Introduction According to the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines [1], chronic kidney disease is defined as kidney damage or glomerular filtration rate (GFR) <60？mL/min/1.73？m2 for 3 months or more, irrespective of cause. The prevalence of CKD in SEEK-India cohort was approximately 17.2% with ~6% having CKD stage 3 or worse [2]. Low protein diet-LPD (0.6？g/kg BW/day) as well as very low protein diet-VLPD (0.3？g/kg BW/day) decreases the accumulation of nitrogen waste products while maintaining an adequate nutritional status [3, 4]. The ideal treatment for CKD-ESRD (end stage renal disease) is renal replacement therapy (RRT) which includes renal transplantation and maintenance dialysis. Since these modalities are costly, required lifelong, not suitable for many patients, associated with many complications, and out of reach of 95–99% of patients, they are managed on conservative therapy [5]. Rhubarb belongs to genus Rheum in the family Polygonaceae. Important derivatives from Rhubarb are anthraquinones like rhein, emodin, and aloe emodin [6]. In CKD, these help