Dietary counseling: the ingredient for successfully addressing the use of herbal supplements and probiotics in chronic kidney disease.

Globally, herbal medicines represent a $60 billion industry, and they account for approximately 20% of the overall drug market. Herbs (or herbals) that improve the taste of foods as flavor enhancement spices can generally be used safely by the CKD patient population. However, many herbals are sold as dietary supplements for medicinal use, and these are regulated as foods not drugs, thus allowing herbal supplements to be sold without premarket evaluation or approval by the Food and Drug Administration. In the absence of required testing, many herbal supplements are manufactured inconsistently with wide variations in composition. It is essential for the nephrology practitioner to assess CKD patients regarding their use of these products to understand their risks and benefits and to educate patients and families. This article will discuss some of the more commonly used products and their potential positive and adverse effects on CKD patients.