What are the considerations for using Renogard (generic name) in patients with Chronic Kidney Disease (CKD)?

Renogard in Chronic Kidney Disease

Renogard is a homeopathic preparation with no established evidence base for use in CKD, and its role should be considered only as adjunctive therapy while prioritizing evidence-based medications that reduce mortality and slow disease progression.

Critical Evidence-Based CKD Management Framework

The foundation of CKD treatment must prioritize medications with proven benefits for reducing kidney disease progression, cardiovascular events, and mortality. The following represents the current standard of care:

Primary Disease-Modifying Therapies

For patients with Type 2 diabetes and CKD (eGFR ≥20 mL/min/1.73 m²):

• SGLT2 inhibitors are strongly recommended as first-line therapy 1
• These agents reduce CKD progression and cardiovascular events regardless of baseline albuminuria when eGFR ≥20 mL/min/1.73 m² 1
• Continue SGLT2i even if eGFR falls below 20 mL/min/1.73 m² once initiated, unless not tolerated or kidney replacement therapy begins 1
• Temporarily withhold during prolonged fasting, surgery, or critical illness due to ketosis risk 1

For patients with albuminuria (with or without diabetes):

• RAS inhibitors (ACEi or ARB) are strongly recommended for moderately-to-severely increased albuminuria (A2-A3) 1
• Use the highest approved tolerated dose, as trial benefits were achieved at these doses 1
• Continue even when eGFR falls below 30 mL/min/1.73 m² 1
• Monitor creatinine and potassium within 2-4 weeks of initiation or dose increase 1
• Continue therapy unless creatinine rises >30% within 4 weeks 1

Nonsteroidal mineralocorticoid receptor antagonists (MRAs):

• May be added to RASi and SGLT2i for patients with T2D and CKD 1
• Initiate only when potassium ≤4.8 mmol/L 1
• Start finerenone 10 mg daily if eGFR 25-59 mL/min/1.73 m², or 20 mg daily if eGFR ≥60 mL/min/1.73 m² 1
• Hold if potassium >5.5 mmol/L; restart at 10 mg when potassium ≤5.0 mmol/L 1
• Monitor potassium at 1 month, then every 4 months 1

Renogard-Specific Considerations

FDA Labeling Information

• Standard adult dosing: 15-20 drops, 3 times daily 2
• Pediatric dosing requires practitioner consultation 2
• Contraindicated in pregnancy/nursing without healthcare professional guidance 2
• Should be discontinued if symptoms persist 2

Critical Safety Gaps

There is no published evidence regarding:

• Renogard's efficacy in slowing CKD progression
• Its effects on cardiovascular outcomes or mortality
• Appropriate dose adjustments based on eGFR
• Drug interactions with evidence-based CKD therapies
• Safety profile in advanced CKD (stages 4-5)

Clinical Integration Approach

If a patient is considering or using Renogard:

1. Ensure evidence-based therapies are optimized first 1

   • SGLT2 inhibitors for appropriate candidates
   • RAS inhibitors for those with albuminuria
   • Blood pressure control targeting SBP <120 mmHg when tolerated 1

2. Monitor for potential interactions 3

   • Be vigilant for inappropriate concomitant drug use, particularly NSAIDs (used inappropriately in 65.8% of CKD patients in one study) 3
   • Ensure no interference with monitoring of evidence-based therapies

3. Maintain standard CKD monitoring 1

   • Annual assessment of urinary albumin and eGFR minimum 1
   • Twice-yearly monitoring for those with albuminuria ≥300 mg/g or eGFR 30-60 mL/min/1.73 m² 1

Common Pitfalls to Avoid

Do not substitute Renogard for proven therapies:

• The mortality and morbidity benefits of SGLT2 inhibitors, RAS inhibitors, and nonsteroidal MRAs are well-established 1, 4
• Empagliflozin reduced the composite outcome of kidney disease progression or cardiovascular death by 28% (HR 0.72) in the EMPA-KIDNEY trial 4

Do not delay evidence-based treatment:

• Early initiation of disease-modifying therapies is critical 5
• RAS inhibitors have been the mainstay of CKD treatment for two decades with proven cardiovascular and renal protection 5

Avoid polypharmacy without benefit:

• Focus on medications with documented kidney and cardiovascular benefits 1
• Inappropriate drug use occurs in 80.5% of CKD patients, increasing with age 3