From the Guidelines
Glucosamine is strongly recommended against in patients with stage 4 renal disease who have arthritis, due to its lack of efficacy and potential risks associated with kidney function and electrolyte imbalance. The primary concern is that glucosamine is primarily eliminated through the kidneys, and in advanced kidney disease (stage 4), the reduced kidney function may lead to accumulation of the supplement in the body, potentially worsening kidney function or causing other complications 1. Additionally, glucosamine supplements often contain significant amounts of sodium or potassium, which need to be carefully restricted in advanced kidney disease. Some glucosamine products are derived from shellfish, which may pose allergy risks for certain patients.
For arthritis management in stage 4 renal disease, safer alternatives should be considered, including:
- Physical therapy
- Appropriate weight management
- Topical pain relievers
- Kidney-friendly pain medications prescribed by a nephrologist. Any supplement or medication decisions should be made in consultation with both a nephrologist and rheumatologist who can evaluate the specific risks based on the patient's exact kidney function, arthritis severity, and overall health status. According to the 2019 American College of Rheumatology guideline, glucosamine is strongly recommended against in patients with knee, hip, and/or hand OA due to its lack of efficacy and potential risks 1.
From the Research
Safety of Glucosamine for Patients with Stage 4 Renal Disease and Arthritis
- There is limited direct evidence on the safety of glucosamine for patients with stage 4 renal disease and arthritis 2, 3, 4, 5, 6.
- However, studies suggest that patients with end-stage renal disease (ESRD) are at increased risk of infection and other complications, which may be relevant to the use of glucosamine 5.
- A study on the epidemiology of ESRD in patients with rheumatoid arthritis found that diabetes and hypertension were the most common primary causes of ESRD, and that the use of DMARDs and biologics to treat RA in the setting of ESRD appears to be infrequent 4.
- Another study found that CKD may exacerbate the progression and impact of osteoarthritis (OA), and that uremic toxins may play a role in the association between CKD and OA 6.
- The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with preexisting cardiovascular disease or ≥ 2 cardiovascular risk factors should be done with caution, according to a systematic review 2.
- Exercise intervention has been shown to improve fatigue, anxiety, depression, physical activity, and quality of life in patients with end-stage renal disease 3.
Potential Risks and Considerations
- Patients with stage 4 renal disease and arthritis should be closely monitored for potential complications and interactions with other medications 2, 4, 5.
- The potential benefits and risks of glucosamine use in this population should be carefully weighed, taking into account the individual patient's medical history and current health status 6.
- Further research is needed to fully understand the safety and efficacy of glucosamine in patients with stage 4 renal disease and arthritis 2, 3, 4, 5, 6.