E-ISSN:2456-3110

Research Article

Chronic Kidney Disease

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 2 February
Publisherwww.maharshicharaka.in

Exploring the efficacy of Ayurvedic interventions in managing Chronic Kidney Disease: A Pilot Study

Semwal A1*, Johri S2, Rajpoot A3
DOI:10.21760/jaims.9.2.6

1* Abhishek Semwal, Post Graduate Scholar, Department of Kayachikitsa, State Ayurvedic College and Hospital, Lucknow, Uttar Pradesh, India.

2 Sharad Johri, Reader, Department of Kayachikitsa, State Ayurvedic College and Hospital, Lucknow, Uttar Pradesh, India.

3 Amit Rajpoot, Post Graduate Scholar, Department of Kayachikitsa, State Ayurvedic College and Hospital, Lucknow, Uttar Pradesh, India.

Introduction: Chronic Renal Failure (CKD) refers to a continual, irreversible reduction in nephron count. Identifying risk factors for CKD, even in those with normal GFR, is crucial factors include hypertension, diabetes, autoimmune issues, older age, African ancestry, family history of renal disease, previous acute renal failure, and indications like proteinuria or structural urinary tract irregularities. Materials and Methods: Study was conducted at the O.P.D. of Dept. of Kayachikitsa, State Ayurveda College & Hospital Lucknow. A total 34 patients were screened out of which 30 Patients meeting inclusion criteria were registered. The patient was given Gokshuradi Guggulu, Mutraghata Har Yoga (MGH Yoga) & Trina Panchmula Kwatha. Results: Out of 26 participants, 57.7% reported relief, 15.4% noted moderate improvement, and 7.7% reported mild improvement. Additionally, 19.2% stated no change, and none reported worsened health. These percentages indicate the intervention's potential effectiveness, with the majority experiencing relief. Discussion: Ayurvedic formulations, such as Trinpanchmool Kwath, Gokshuradi Guggulu, And MGH Yoga, exhibit promise in CKD management by addressing oxidative stress, diuretic action, and nephroprotective qualities.

Keywords: Ayurveda, CKD, Gokshuradi Guggulu, MGH Yoga & Trina Panchmula Kwatha

Corresponding Author How to Cite this Article To Browse
Abhishek Semwal, Post Graduate Scholar, Department of Kayachikitsa, State Ayurvedic College and Hospital, Lucknow, Uttar Pradesh, India.
Email: 		Semwal A, Johri S, Rajpoot A, Exploring the efficacy of Ayurvedic interventions in managing Chronic Kidney Disease: A Pilot Study. J Ayu Int Med Sci. 2024;9(2):29-38.
Available From
https://jaims.in/jaims/article/view/2982

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-12-15 2023-12-25 2024-01-05 2024-01-15 2024-01-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.41

© 2024by Semwal A, Johri S, Rajpoot Aand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

The Samhita period (2000-1000 B.C) is supposed to be the golden period when Ayurveda flourished as a scientific and systemic system of physiology, etiopathogenesis, classification and management of disease of the urinary system are available. Ancient Acharya detailed about the 13 types of Mutraghata (Obstructive and suppressive uropathies), 8 types of Mutrakrichha (dysuria), and 20 types of Prameha (metabolic disease) but no one has a complete resemblance to CKD. Only Mutrasada and Mutrakshaya have some similarities in the features of oliguria and anuria which are the characteristics of the advanced stage of CKD and ESRD. Chronic kidney disease (CKD), refers to an irreversible deterioration in renal function in which the body’s ability to sustain metabolic fluid and electrolyte balance fails, which usually develops over a period of years. Initially, it manifests only as a biochemical abnormality but, eventually, loss of the excretory, metabolic, and endocrine functions of the kidney leads to the clinical symptoms and signs of renal failure, resulting in uremia or Azotemia. It is considered a long-term form of kidney disease and is differentiated from acute kidney disease in that the reduction in kidney function must be present for over 3 months.[1]

The modern management of CKD is not satisfactory and the ultimate goal is renal transplant. It seeks attention from nephrologists and researchers to find out suitable remedial measure from other alternative resources. Ayurvedic medicine may provide new therapeutic options for patients with CKD and may mitigate symptoms and improve health-related Quality of life (QOL), which conventional therapies such as drugs and dialysis may not achieve. However, the short-term as well as possible long-term complications attributed to their use are presently unknown.

Review of the literature

Modern Review: Chronic Renal Failure refers to a continual, irreversible reduction in nephron count. Identifying risk factors for CKD, even in those with normal GFR, is crucial - factors include hypertension, diabetes, autoimmune issues, older age, African ancestry, family history of renal disease, previous acute renal failure, and indications like proteinuria or structural urinary tract irregularities.

According to KDOQI, CKD encompasses kidney abnormalities or damage markers, with or without decreased GFR, persisting for ≥ 3 months, with a GFR < 60 ml/min/1.73 m2. NKF's classification divides CKD into 5 stages based on GFR: from physiological decompensation (stage I) with GFR > 90 ml/min to End-Stage Renal Failure (ESRD - stage V) with GFR < 15 ml/min.[2]

Stages 1 and 2 CKD typically show no GFR-related symptoms, but underlying renal issues like oedema or hypertension may manifest. In stages 3 and 4, complications become more apparent - manifesting across multiple organ systems - including anaemia, malnutrition, mineral and hormone imbalances, and disturbances in electrolyte and fluid balance. By stage 5 CKD, toxin buildup severely impacts daily life, causing marked disturbances in well-being, nutrition, and overall health, culminating in the uremic syndrome.[3]

Ayurvedic Review: Acharya Charaka wisely noted that naming diseases isn't always the key. What truly matters is understanding symptoms and effectively treating them.

CRF is an entity of varied etiology; it is also termed as a syndrome and is considered as Sannipataj Vyadhi. CRF may be termed as a Vyadhi Sankar consisting of various conditions e.g. Prameha (Diabetes Mellitus), Shotha (oedema), Pandu (Anaemia), Udavart, Vata Vyadhi, Mutraghata, Mutra Jathar, Mutrakshay, Mutra Kriccha etc.[4]

Hetu (cause) behind vitiated Raktavaha, Medovaha, Mutravaha, and Svedavaha Srotas are responsible for the etiology of Vrikka Vikar (Nephropathy). In CRF there is Asthi Vaha Srotas Dusti present in Sookshma form. It is corroborated by the modern concept of Hypocalcaemia occurring in CRF due to a deficiency of hormone calcitriol-D3. Anemia is a prominent characteristic of Chronic Kidney Disease (CKD), and the principles of Pandurog Chikitsa and Shotha Chikitsa can be effectively applied in the management of both anemia and swelling associated with CKD.

Hetu (Causes) as per Ayurveda

  • Bija Doşa
  • Vega Dharana (esp. Apana Related)
  • Marmabhighata
  • Viṣamasana

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  • Diseases Of Mutravaha Srotas g. Mutrakṛcchra, Mutraghata, Asmari, Arbuda, Granthi, Prameha especially Madhumeha
  • Bala Bhramsa
  • Ama
  • Jirna Jvara
  • Daiva

Samprapti Ghatak

  • Dosas: May vary according to basic etiopathogenesis. However, a Tridosaja condition often dominance of Kapha later Vata involvement takes place.
  • Duşyas: Mutra, Rasa, Udaka, Sveda, Rakta, Sira are the basic Duṣyas. Later all Dhatus and Upadhatus may get involved. Clinical conditions related to Snayu, Mamsa, Asthi, and Sukra are often observed
  • Srotas: Mutravaha, Medovaha, Udakavaha, Svedavaha, Rasavaha, Raktavaha as disease advances becomes multi-srotas (multi-system).
  • Srotoduşți in Mutravaha Srotas Kharatava, Kathinya, Gaurava , Rauksya
  • Agni & Ama: Generally, Agni is Manda at every level mostly Malasamcayatmaka Ama is present
  • Udbhavasthana: Pakvasayottha
  • Rogamarga (Route): initially Madhyama Marga but later all three Marga, which increases its incurability.

Drug Review

Trina Panchamoola Kwatha, renowned for its Vata-Pitta pacifying, diuretic, kidney-stimulating, and hemopoietic properties, holds promise in chronic kidney disease treatment. Its ingredients, outlined in Mutra Virechniya Dashemani, are traditionally used for asthma, anemia, and diuretic purposes. In vitro studies indicate its potential in scavenging free radicals, suggesting a role in conditions involving oxidative stress.[5] Gokshuraadi Guggulu, known for its diuretic action, not only reduces fluid overload in renal impairment but also strengthens the renal and cardiac systems.[6] With its focus on Mutravaha Srotas, it addresses conditions like Mutrakrichhra, Mutraghata, Ashmari, and Prameha. Possessing Tridoshahara, Madhura, Tikta, and Katu Rasa

Pradhan properties, it is effective against pain during micturition, UTIs, edema, BPH, and chronic renal failure.[7] Its broad-spectrum anti-inflammatory and nephroprotective qualities, along with lymphatic detoxification, make it a potent herbal remedy for kidney health.[8] Mutraghata Har Yog[9] contains Punarnava and Makoi work synergistically to protect the kidneys from damage induced by diabetes, particularly safeguarding the nephrons. Kaasni contributes to electrolytic homeostasis by enhancing Na+ K+ ATPase activity, rectifying serum electrolyte imbalances, and maintaining Glomerular Filtration Rate (GFR).[10] Shigru is rich in antioxidant, anti-inflamatory and diuretic phytoconstituents, potentially prevent renal damage and reducing the frequency of renal dialysis significantly.[11] Shigru, along with Saariva, aids in preserving cellular integrity and kidney architecture, preventing renal injuries, and improving hemopoiesis.[12] Varun's nephroprotective properties stem from the antioxidant and free radical scavenging attributes of its lupeol alkaloid. Guduchi exhibits antioxidant, hypoglycemic, and hypolipidemic effects, addressing dyslipidemia and cardiac disorders, common complications in Chronic Kidney Disease (CKD).[13] Pravaal Pisthi, a source of calcium carbonate, helps prevent bone demineralization and acidosis, addressing late-stage complications of CKD.[14]

Aim and Objectives

1. To Evaluate the Effect of Ayurveda Regimen In The Cases of Chronic Kidney Disease.

2. To Evaluate the Effect of Indigenous Formulations In The Management Of CKD.

3. To Assess the Effectiveness of The Drugs On Selected Subjective And Objective Parameters.

4. To Assess the Side Effect of Trial Drugs If Any

Materials and Methods

Selection of the patients: Study was conducted at the O.P.D. of Dept. of Kayachikitsa, State Ayurveda College & Hospital Lucknow. A total 34 patients were screened out of which 30 Patients meeting inclusion criteria were registered.

Method of Treatment/Intervention: The patient was given Gokshuradi Guggulu, Mutraghat Har Yoga (MGH Yoga) along with Trina Panchmula Kwatha as Anupana.


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  • Dose of Gokshuradi Guggulu: 2 Tab each 250mg, (Twice daily) after the meal
  • Dose of MGH Yoga: 2 Tab 500mg (Twice Daily) after a meal
  • Dose of Trina Panchmula Kwatha: 40ml (Twice daily) as Anupana

Type of Study: Pilot Study

Period of Study: 90 Days

Sample Size: 30 patients

Duration: 90 days

Follow Up During Treatment: D15, D30, D45, D60, D75, D90

Follow-Up After-Treatment: 7 days (without drug) after treatment is completed.

Ethics Committee Clearance and Consent: As this was clinical research, Institutional Ethics Committee (IEC) approval was taken. Its approval number is SAC/IEC/2021/28 dated 17/09/2021.

CTRI: This research study was registered in the Clinical Trials Registry - India. The CTRI registration number of the present study, CTRI/2022/09/045326 registered on 08/09/2022 prior to the initiation of research work.

Inclusion Criteria

  • Age- 35-65 years
  • History of reduction of kidney function must be present over 3 months.
  • Serum Creatinine level above 1.4 mg/dl and below 4.6 mg/dl
  • Serum Urea level above 40mg/dl and below101mg/dl
  • Patient having Hb level >8gm/dl
  • GFR 30- 90ml/min/1.73m2
  • BUN [Blood urea Nitrogen] above 18.6mg/dl and below 46.8mg/dl

Symptoms

A. Essential Criteria

Objective Criteria

1. Blood Urea

2. Serum Creatinine

3. GFR (Glomerular filtration rate)

4. Blood Urea Nitrogen

B. Non-Essential Criteria

Subjective Non-Essential

1. Mutravarodha (obstructed Micturition

2. Mutrakruchra (difficulty micturition)

3. Mutradaha (burning micturition)

4. Anorexia

5. Vomiting

6. Pruritis

7. Oedema

8. Nocturia

9. Thirst

10. Dozing & Sleeplessness

11. Dyspnoea

Objective Non-Essential

1. Anaemia

2. Lipid Profile

3. Mutralpata (Oliguria)

Exclusion Criteria

1. Age below 35 and above 65 years.

2. Blood Urea more than 100mg/dl and below 41mg/dl

3. Serum creatinine level above 4.5 mg/dl and below 1.5mg/dl

4. BUN [Blood urea Nitrogen] above 46.7mg/dl and below 18.7mg/dl

5. GFR < 30ml/min/1.73m2 and > 90ml/min/1.73m2

6. Patients under frequent dialysis

7. Uncontrolled Diabetes mellitus

8. Malignant Hypertension

9. Grade III Prostate

10. Prostate Carcinoma

11. Tubercular Nephritis

12. Hypovolemia


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13. Liver Failure

14. Heart Failure

15. Acute Myocardial Infarction

16. Sever Valvular Disease

17. Tense Ascites

18. Sepsis

19. Hemorrhage

20. Pancreatitis

21. Renal artery/ vein obstruction

22. Microangiopathies like DIC, TTP

23. Systemic Diseases like lupus, lymphoma, Leukemia, sarcoidosis

24. Congenital Disease of kidney: Polycystic kidney disease

25. Transplant allograft failure

Objective Parameters

  • Essential Criteria

1. Blood Urea

Grademg/dl
0≤ 40mg/dl
141-60mg/dl
261-80mg/dl
3>81 mg/dl

2. Serum Creatinine

Grademg/dl
0Below 1.5
11.5-3.0
23.1-4.5
3Above 4.5

3. GFR (Glomerular filtration rate)

GradingFeaturesGFR ml/min/1.73m2
0Kidney damage with normal or ↑ GFR≥ 90
1Kidney damage with mild ↓ GFR60 – 89
2Moderate ↓ GFR30 – 59
3Severe ↓ GFR< 30

4. Blood Urea Nitrogen (BUN) mg/dl

GradeBUN (mg/dl)Severity
0<18.7Normal
118.8-28.0Mild
228.1-46.7Moderate
3>46.7Severe

  • Non-Essential Criteria

1. Mutralpata (Oliguria)

Grademl/24hr
0> 400ml/24hr
1400-250ml/24hr
2249-100ml/24hr
3100ml/24hr

2. Anaemia (Hb %)

GradeGm/dl
0≥ 12.1 (Normal)
110.1-12.0
28.1-10.0
3≤8.0

3. Lipid profile

GradeSeveritySerum Cholesterol (mg/dl)LDL (mg/dl)HDL (mg/dl)Triglyceride (mg/dl)
0Ideal< 200<100>60<150
1Borderline201-239101-15940-59 ♀
50-59 ♂		151-199
2High/low240-499160-18939-20 ♀
49-30 ♂		200-499
3Very High/ Very low≥500≥190≤ 20 ♀
≤ 30 ♂		≥500

Subjective Parameters

  • Non-Essential Symptoms

1. Mutravarodha (Obstructed Micturition)

GradeFeatures
0No obstruction during the act of micturition
1Rare obstruction during micturition or at start of micturition
2Obstruction at the start and/ or during the whole act of micturition most of the time.
3Complete obstruction of voluntary act of micturition but dribbling or incontinence may present

2. Mutrakrichrata (Difficulty in micturition)

GradeFeatures
0No Difficulty
1Difficulty present at the beginning of act
2Difficulty present at the beginning of act and partially during the rest of act
3Difficulty present throughout the act

3. Mutradaha (Burning micturition)

GradeFeatures
0No Burning
1Mild- rare burning in morning / at start of act
2Tolerable burning at starting, during micturition
3Not tolerable at starting, during micturition and sustained after micturition.

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4. Anorexia

GradeFeatures
0Absent
1Reduced Appetite
2Very reduced Appetite
3Almost complete loss of appetite

5. Vomiting

GradeFeatures
0Absent
11 Episode in 24 hrs
22-5 episodes in 24 hrs
3>5 episodes in 24hrs

6. Dozing or Sleepiness (EPWORTH Sleepiness Scale)

GradeScoreFeatures
00 -10Normal Range in healthy adults
111-14Mild Sleepiness
215-17Moderate Sleepiness
318 or higherSevere sleepiness

7. Nocturia

GradeFeatures
0No Voids / night
1Mild (1-2 Voids/ night)
2Moderate (3-4 voids/ night)
3Severe (> 4 voids/ night)

8. Thirst

GradeFeatures
0Feeling of thirst (7-9 times/ 24hrs) and relieved by drinking water
1Feeling of moderate thirst (>9-11 times/24hrs) and relieved by drinking water
2Feeling of excess thirst (>11-13 times/24hrs) not relieved by drinking water
3Feeling of severe thirst (>13 times) not relieved by drinking water

9. Pruritis

GradeFeatures
0No Pruritis (Absent)
1Mild (Pruritis is episodic and localized without disturbance in routine work)
2Moderate (Pruritis is generalised and continuous without any sleep disturbance)
3Severe (Pruritis is generalised and continuous disturbing sleep)

10. Oedema

GradeFeatures
0No Oedema
1Oedema over eyelids
2Oedema over eyelids + face + ankle
3Generalised oedema

11. Breathlessness (NYHA New York Heart Association)

GradeFeatures
0No symptoms and no limitation in ordinary activity e.g., shortness of breath when walking climbing stairs etc.
1Mild symptoms (mild shortness of breath and or angina and slight limitation during ordinary activities)
2Marked limitation in activity due to symptoms even during less than ordinary activity e.g., walking short distances (20-100meters) comparable only at rest
3Severe limitation (experience symptoms even while at rest mostly bed bound patients)

Investigations

  • Renal Function Test [Blood urea, Sr. Creatinine, GFR, BUN] / Fortnightly
  • Following test will be done monthly
  • CBC
  • HB%
  • Erythrocyte’s sedimentation rate (ESR
  • Liver Function Test [Sr. Bilirubin, SGOT, SGPT, Alkaline Phosphatase (ALP)]
  • Serum Uric Acid
  • Lipid profile [Total cholesterol, Total glycerides, LDL, HDL]
  • Urine routine and microscopic /M
  • Following 3 Test will be done before and after treatment.
  • Blood Sugar (Fasting & Postprandial) in non-diabetic patients
  • HBA1C in both diabetic and non-diabetic patients
  • USG - Whole abdomen/ KUB region
  • FBS, PPBS twice a week in a Diabetic patient.
  • Serum Na+, K+, Cl-, Phosphorus as per requirement of patients condition
  • X-ray chest PA View (if required)
  • Echocardiography (if required)
  • Doppler Ultrasonography (if required)
  • Renal Biopsy (if required)
  • Prostate-specific Antigen (PSA) (if required)
  • PTH (if required)
  • Culture sensitivity (if required)

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Assessment of objective criteria

Criteria for assessment of Creatinine - To calculate the % relief in creatinine, the formula used was

% relief in Creatinine = (B.T. - A.T.)/ (B.T.-1.5) x 100

Criteria for assessment of blood urea - To calculate the % relief in blood urea, the formula used was

% relief in blood urea= (B.T. - A.T.)/ (B.T. - 40) x 100

Total effect of therapy

The total effect of therapy of this trial will be grouped as follows

1. Relieved

  • Patients having 76-100 % relief in terms of symptoms
  • ≥ 50% improvement in the initial value of essential objective criteria.

2. Improved

Patients have improvement between 51-75% in clinical symptoms.

  • Mild Improvement

a) Improvement between 51-63.5% in clinical symptoms.

b) Upto 24.9% improvement in the initial value of essential objective criteria.

  • Moderate Improvement

a) Improvement between 63.5-75% in clinical symptom

b) ≥25% and <49.9% improvement in the initial value of essential objective criteria

3. Unchanged

a) Patients having improvement of less than 50% in terms of clinical symptoms.

b) Pathological findings (Blood Urea, Serum Creatinine, GFR, and BUN) remain the same as before the trial.

4. Worsened

a) Patients have no improvement in terms of clinical symptoms.

b) Pathological findings get disturbed (Blood urea and Creatinine level, BUN may get increased & GFR goes down).

Observation

In the present study, a total of 30 patients were registered out of which 26 completed the trial and 4 patients left the trial.

Among 30 participants, demographic analysis revealed a predominant age bracket of 55-65 years, with males constituting 63.3%. Hypertension was prevalent in 73.33%, and 46.7% Diabetic. About 26.7% were having obstructed micturition, 23.3% experienced difficulty in micturition, and 36.7% had burning micturition. Anorexia was prevalent, with 86.7% while vomiting was reported by 10.0% of subjects. 10.0% reported dozing or sleepiness, 23.3% experienced nocturia, and increased thirst was noted in only 3.3% of cases. Pruritis was reported by 36.7%, oedema by 93.3%, and breathlessness by 66.7%. Interestingly, no subjects reported oliguria, resulting in a 0.0% percentage. Anemia based on hemoglobin levels was prevalent, with 76.7% reporting it.

Observation on essential and non-essential criteria:

Essential Objective Criteria% ChangeMean ChangeP-Value
Blood Urea37.227.560.015
Serum Creatinine44.440.38<0.001
eGFR (Estimated
Glomerular filtration rate)		25.00-11.100.003
Blood Urea Nitrogen (BUN) mg/dl29.314.210.007

Non-Essential Subjective Parameters% ChangeP-Value
Obstructed Micturition88.460.020
Difficulty in micturition61.540.059
Burning micturition100.000.002
Anorexia75.71<0.001
Vomiting100.000.083
Dozing or Sleepiness100.000.083
Nocturia65.380.020
Thirst100.000.317
Pruritis100.000.005
Oedema63.80<0.001
Breathlessness73.78<0.001
Non-Essential Objective Criteria% ChangeP-Value
Anemia Hb% (Grade)35.900.008
Lipid Profile (Grade)6.250.414
OliguriaNANA


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Non Essential Objective CriteriaMean ChangeP-Value
Uric Acid (mg/dl)-0.020.932
Hb (gm/dl)-0.150.694
TLC Cells/mm3215.040.706
Neutrophils %-2.240.288
Lymphocytes %-0.900.597
Monocytes %0.580.650
Eosinophil %0.510.488
Basophil %-0.040.446
Total RBC Count0.050.613
Total platelet count (x103)-1.920.796
FBS mg/dl9.210.323
PPBS mg/dl18.120.279
HBA1C0.320.070
Sodium mmol/L-0.770.550
Potassium mmol/L0.150.351
Total cholesterol mg/dl4.050.562
HDL mg/dl-2.410.324
LDL mg/dl2.680.509
Triglycerides mg/dl7.230.241
Serum Bilirubin mg/dl-0.040.486
SGOT IU/ml3.590.060
SGPT IU/ml0.510.733
ALP IU/l10.480.450

Result

Out of 26 participants, 57.7% reported relief, 15.4% noted moderate improvement, and 7.7% reported mild improvement. Additionally, 19.2% stated no change, and none reported worsened health. These percentages indicate the intervention's potential effectiveness, with the majority experiencing relief.

Final StatusNo. (N=26)%
Relieved1557.7%
Moderate Improvement415.4%
Mild Improvement27.7%
Unchanged519.2%
Worsened00.0%

Discussion

Chronic Kidney Disease (CKD) poses a global public health crisis, impacting quality of life and economies. Ancient Ayurvedic texts indirectly reference CKD through conditions like Mutrasada and Mutrakshaya, offering insights into its recognition and progression. Ayurveda interprets CKD as Mutravaha Srotas disorders, focusing on

personalized treatments based on Dosha, Dhatu, and Mala imbalances. Ayurvedic formulations, such as Trinpanchmool Kwath, Gokshuradi Guggulu, and Mutraghata Har Yoga, exhibit promise in CKD management by addressing oxidative stress, diuretic action, and nephroprotective qualities.

Conclusion

This pilot study aimed to evaluate the impact of an Ayurvedic regimen on Chronic Kidney Disease (CKD), providing valuable insights for future research. Key conclusions include the recognition of CKD as a complex disorder with varied etiology, highlighting the prevalence and demographics of CKD globally and in India. The study a safe and effective Ayurvedic regimens, with the combination of Trinpanchmool Kwath, Gokshuradi Guggulu, and Mutraghat Har (MGH) Yoga and emerging as promising for CKD management.

Acknowledgement

The authors are thankful to all the patients who willingly participated in this study. The authors are also thankful to the management of State Ayurvedic College and Hospital, Lucknow for providing necessary assistance for completion of this research project.

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