Extracorporeal Ozonation and Oxygenation is NOT Effective or Recommended for Chronic Kidney Disease
Extracorporeal ozonation and oxygenation (EBOO/ECO) should not be used for treating chronic kidney disease, as there is no high-quality evidence supporting its efficacy, and it is not mentioned in any established CKD management guidelines.
Evidence Base and Guideline Recommendations
The current management guidelines for CKD, including the widely recognized Kidney Disease Improving Global Outcomes (KDIGO) guidelines, emphasize early detection, blood pressure control, glycemic control in diabetic patients, proteinuria reduction, lifestyle modifications, and regular monitoring of kidney function 1. None of the established CKD management guidelines recommend or even mention extracorporeal ozonation and oxygenation as a treatment modality 1.
The only available evidence for EBOO consists of:
- A preliminary 2000 report describing anecdotal use in a volunteer and a few patients with atherosclerotic vasculopathy and Madelung disease, not CKD 2
- A 2005 review discussing theoretical mechanisms and preliminary experience in 82 patients with various conditions (peripheral arterial disease, coronary disease, severe dyslipidemia, sudden deafness), but not chronic kidney disease 3
Standard Evidence-Based CKD Management
The multidisciplinary approach to CKD management should focus on 1:
- Blood pressure control targeting appropriate levels based on CKD stage and proteinuria status 1
- Glycemic control in diabetic patients to slow progression 1
- Proteinuria reduction using ACE inhibitors or ARBs when appropriate 4, 1
- Dietary modifications including sodium restriction to <2.0 g/day 4
- Regular monitoring of kidney function, electrolytes, and complications 4, 5
- Management of CKD complications including anemia, mineral-bone disease, cardiovascular disease, and volume excess 5
Extracorporeal Therapies That ARE Evidence-Based in Kidney Disease
When extracorporeal treatments are discussed in legitimate guidelines, they refer to 6:
- Hemodialysis for end-stage kidney disease or severe acute kidney injury 6
- Continuous renal replacement therapy (CRRT) for critically ill patients with acute kidney injury 6
- Extracorporeal membrane oxygenation (ECMO) for cardiopulmonary failure, though this commonly causes acute kidney injury as a complication rather than treating it 7, 8
Critical Pitfalls and Safety Concerns
The lack of randomized controlled trials, absence from clinical guidelines, and extremely limited published experience make EBOO/ECO an unproven and potentially harmful intervention for CKD patients 3, 2. The 2005 review itself acknowledges that "clinical application and validation of AHT [autohemotherapy with ozone] have been so far largely insufficient" and calls for "extensive investigation on oxidative stress biomarkers and clinical trials" 3.
CKD patients are already at increased risk for cardiovascular complications, oxidative stress, and require careful medication management 6, 5. Introducing an unvalidated extracorporeal therapy with pro-oxidant properties could potentially worsen outcomes 6.
Conclusion on Clinical Practice
Patients with CKD should receive evidence-based therapies as outlined in KDIGO and other established guidelines 1. If considering any novel or alternative therapy, clinicians must weigh the complete absence of evidence for EBOO/ECO in CKD against the robust evidence base for standard interventions 1. The frequency of CKD complications increases with disease stage, making adherence to proven management strategies essential 5.