Does glucosamine (glucosamine) have adverse effects on patients with Chronic Kidney Disease (CKD)?

Glucosamine and Adverse Effects in Chronic Kidney Disease

Glucosamine should be used with caution in patients with CKD due to potential nephrotoxicity, as it can cause tubulointerstitial fibrosis and acute tubular necrosis in rare cases.

Potential Adverse Effects of Glucosamine in CKD

Glucosamine, a commonly used supplement for osteoarthritis, has several potential adverse effects in patients with chronic kidney disease:

• Direct nephrotoxicity: Case reports have documented tubulointerstitial nephropathy induced by glucosamine, with biopsy evidence showing non-inflammatory fibrosis of the renal cortex associated with acute tubular necrosis 1

• Reduction in GFR: Evidence shows that glucosamine can cause significant reductions in glomerular filtration rate, with one case demonstrating a drop from 86 to 46 mL/min within 3 months of use 1

• Reversible kidney injury: The nephrotoxicity appears to be reversible upon discontinuation of the supplement, with improvement in kidney function observed within weeks of stopping glucosamine 1

• Dose and duration dependent: The adverse effects appear related to prolonged use (e.g., 3 years of daily use at 1,200 mg) 1

Mechanism of Kidney Injury

The pathophysiological mechanisms by which glucosamine may affect kidney function include:

• Induction of apoptosis in kidney tubular and mesangial cells
• Overexpression of transforming growth factor β1 (TGF-β1) and connective-tissue growth factor (CTGF)
• Promotion of mesangial and interstitial tubulointerstitial fibrosis 1

Risk Assessment and Monitoring

For patients with CKD who are considering or currently using glucosamine:

• Baseline kidney function: Establish baseline kidney function before starting glucosamine
• Regular monitoring: Monitor kidney function periodically in patients with CKD who are taking glucosamine
• Dose consideration: Consider lower doses in patients with reduced kidney function
• Alternative treatments: Consider alternative treatments for osteoarthritis in patients with advanced CKD

Clinical Recommendations

1. For patients with advanced CKD (eGFR <30 mL/min/1.73m²): Avoid glucosamine due to potential nephrotoxicity and limited clearance

2. For patients with moderate CKD (eGFR 30-60 mL/min/1.73m²): Use with caution and monitor kidney function regularly

3. For patients with mild CKD (eGFR >60 mL/min/1.73m²): May use with periodic monitoring of kidney function

4. For all CKD patients: Discontinue glucosamine if deterioration in kidney function is observed

Alternatives for Osteoarthritis Management in CKD

Since pain management is important for patients with osteoarthritis and CKD, consider these alternatives:

• Non-pharmacological approaches: Physical therapy, weight management, and appropriate exercise programs 2, 3

• Pharmacological alternatives: When needed, carefully selected analgesics with appropriate dose adjustments for kidney function 4

• Caution with NSAIDs: While NSAIDs should generally be avoided in CKD, their risk is primarily associated with long-term usage at high cumulative doses 4

Key Pitfalls to Avoid

• Underrecognition of nephrotoxicity: The nephrotoxic effects of glucosamine may be underreported and not widely recognized 1

• Failure to monitor: Not monitoring kidney function in CKD patients taking glucosamine can lead to undetected kidney injury

• Assuming safety: Despite being a "natural" supplement, glucosamine carries real risks for patients with kidney disease

While the evidence for glucosamine nephrotoxicity comes primarily from case reports rather than large clinical trials, the potential for harm warrants a cautious approach in patients with CKD, especially given the availability of alternative management strategies for osteoarthritis.