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Licensed Unlicensed Requires Authentication Published by De Gruyter July 1, 2013

The use of an anti-inflammatory supplement in patients with chronic kidney disease

Jennifer J. Moreillon, Rodney G. Bowden, Erika Deike, Jackson Griggs, Ron Wilson, Brian Shelmadine, Matt Cooke and Alexander Beaujean


Chronic kidney disease (CKD) is characterized by a continuous reduction in kidney function, increased inflammation, and reduced antioxidant capacity. The objective of this study was to assess the effects of a herbal supplement on systemic inflammation and antioxidant status in non-dialysis CKD patients. Sixteen patients with CKD (56.0±16.0 yrs, 171.4±11.9 cm, 99.3±20.2 kg) were randomly chosen to receive a herbal supplement composed of Curcuma longa and Boswellia serrata, or placebo. Plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), glutathione peroxidase (GPx), and serum C-reactive protein (CRP) were measured at baseline and 8 weeks. Baseline data demonstrated elevated inflammation and low antioxidant levels. A significant time effect (p=0.03) and time x compliance interaction effect (p=0.04) were observed for IL-6. No significant differences were observed for any other variables. This study demonstrates that mild and moderate CKD is associated with chronic inflammation and low antioxidant activity. Systemic inflammation and impaired antioxidant status may be greater in CKD populations with multiple comorbidities. Curcumin and Boswellia serrata are safe and tolerable and helped to improve the levels of an inflammatory cytokine.


The authors thank the entire staff of the Family Health Center for making this study possible, especially CraShanta Evans, Toni Marshall, and Linda Garcia. The supplements used in this project were donated by Life Extension, Inc.


1. Centers for Disease Control and Prevention. National chronic kidney disease fact sheet: general information and national estimates on chronic kidney disease in the united states, 2010. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, 2010.Search in Google Scholar

2. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003;289(1):76–9.10.1001/jama.289.1.76Search in Google Scholar

3. Weiner DE. Causes and consequences of chronic kidney disease: implications for managed health care. JMCP 2007;13(3 Suppl):S1–S9.10.18553/jmcp.2007.13.s3.1Search in Google Scholar

4. Dervisoglu E, Kir HM, Kalender B, Caglayan C, Eraldemir C. Serum fetuin–a concentrations are inversely related to cytokine concentrations in patients with chronic renal failure. Cytokine 2008;44(3):323–327. doi:10.1016/j.cyto.2008.08.01410.1016/j.cyto.2008.08.014Search in Google Scholar

5. Oner-Iyidogan Y, Oner P, Kocak H, Gurdol F, Bekpinar S, Unlucerci Y, et al. Dimethylarginines and inflammation markers in patients with chronic kidney disease undergoing dialysis. Clin Exp Med 2009. doi:10.1007/s10238–009–0035–310.1007/s10238-009-0035-3Search in Google Scholar

6. Pawlak K, Mysliwiec M, Pawlak D. Oxidative stress, phosphate and creatinine levels are independently associated with vascular endothelial growth factor levels in patients with chronic renal failure. Cytokine 2008;43(1):98–101. doi:10.1016/j.cyto.2008.03.01110.1016/j.cyto.2008.03.011Search in Google Scholar

7. Rastmanesh MM, Bluyssen HA, Joles JA, Boer P, Willekes N, Braam B. Increased expression of SOCS3 in monocytes and SOCS1 in lymphocytes correlates with progressive loss of renal function and cardiovascular risk factors in chronic kidney disease. Eur J Pharmacol 2008;593(1–3):99–104. doi:10.1016/j.ejphar.2008.07.01310.1016/j.ejphar.2008.07.013Search in Google Scholar

8. Ceballos-Picot I, Witko-Sarsat V, Merad-Boudia M, Nguyen AT, Thevenin M, Jaudon MC, et al. Glutathione antioxidant system as a marker of oxidative stress in chronic renal failure. Free Radic Biol Med 1996;21(6):845–53.10.1016/0891-5849(96)00233-XSearch in Google Scholar

9. El-Far MA, Bakr MA, Farahat SE, Abd El-Fattah EA. Glutathione peroxidase activity in patients with renal disorders. Clin Exp Nephrol 2005;9(2):127–31. doi:10.1007/s10157–005–0343–110.1007/s10157-005-0343-1Search in Google Scholar

10. Moradi H, Pahl MV, Elahimehr R, Vaziri ND. Impaired antioxidant activity of high-density lipoprotein in chronic kidney disease. Trans Res 2009;153(2):77–85. doi:10.1016/j.trsl.2008.11.00710.1016/j.trsl.2008.11.007Search in Google Scholar

11. Zachara BA, Koterska D, Manitius J, Sadowski L, Dziedziczko A, Salak A, et al. Selenium supplementation on plasma glutathione peroxidase activity in patients with end-stage chronic renal failure. Biol Trace Elem Res 2004;97(1):15–30. doi:10.1385/BTER:97:1:1510.1385/BTER:97:1:15Search in Google Scholar

12. Batista Junior ML, Lopes RD, Seelaender MC, Lopes AC. Anti-inflammatory effect of physical training in heart failure: role of TNF-alpha and IL-10. Arq Bras Cardiol 2009;93(6):643–51, 692–700.10.1590/S0066-782X2009001200021Search in Google Scholar

13. Mena MP, Sacanella E, Vazquez-Agell M, Morales M, Fito M, Escoda R, et al. Inhibition of circulating immune cell activation: a molecular antiinflammatory effect of the mediterranean diet. Am J Clin Nutr 2009;89(1):248–56. doi:10.3945/ajcn.2008.2609410.3945/ajcn.2008.26094Search in Google Scholar PubMed

14. Goicoechea M, de Vinuesa SG, Lahera V, Cachofeiro V, Gomez-Campdera F, Vega A, et al. Effects of atorvastatin on inflammatory and fibrinolytic parameters in patients with chronic kidney disease. J Am Soc Nephrol 2006;17(12 Suppl 3):S231–S235. doi:10.1681/ASN.200608093810.1681/ASN.2006080938Search in Google Scholar PubMed

15. Stenvinkel P, Andersson P, Wang T, Lindholm B, Bergstrom J, Palmblad J, et al. Do ACE-inhibitors suppress tumour necrosis factor-alpha production in advanced chronic renal failure? J Intern Med 1999;246(5):503–7.10.1046/j.1365-2796.1999.00560.xSearch in Google Scholar PubMed

16. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. Trends in alternative medicine use in the united states, 1990–1997: results of a follow-up national survey. JAMA 1998;280(18):1569–75.10.1001/jama.280.18.1569Search in Google Scholar PubMed

17. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United states, 2002. Adv Data 2004;343(343):1–19.10.1016/j.sigm.2004.07.003Search in Google Scholar

18. Hatcher H, Planalp R, Cho J, Torti FM, Torti SV. Curcumin: from ancient medicine to current clinical trials. Cell Mol Life Sci 2008;65(11):1631–1652. doi:10.1007/s00018–008–7452–410.1007/s00018-008-7452-4Search in Google Scholar PubMed PubMed Central

19. Fu Y, Zheng S, Lin J, Ryerse J, Chen A. Curcumin protects the rat liver from CCl4-caused injury and fibrogenesis by attenuating oxidative stress and suppressing inflammation. Mol Pharmacol 2008;73(2):399–409. doi:10.1124/mol.107.03981810.1124/mol.107.039818Search in Google Scholar PubMed

20. Kuhad A, Pilkhwal S, Sharma S, Tirkey N, Chopra K. Effect of curcumin on inflammation and oxidative stress in cisplatin-induced experimental nephrotoxicity. J Agric Food Chem 2007;55(25):10150–5. doi:10.1021/jf072396510.1021/jf0723965Search in Google Scholar PubMed

21. Reyes-Gordillo K, Segovia J, Shibayama M, Vergara P, Moreno MG, Muriel P. Curcumin protects against acute liver damage in the rat by inhibiting NF-kappaB, proinflammatory cytokines production and oxidative stress. Biochim Biophys Acta 2007;1770(6):989–96. doi:10.1016/j.bbagen.2007.02.00410.1016/j.bbagen.2007.02.004Search in Google Scholar PubMed

22. Ghosh SS, Massey HD, Krieg R, Fazelbhoy ZA, Ghosh S, Sica DA, et al. Curcumin ameliorates renal failure in 5/6 nephrectomized rats: the role of inflammation. Am J Physiol Ren Physiol 2009. doi:10.1152/ajprenal.90732.200810.1152/ajprenal.90732.2008Search in Google Scholar

23. Usharani P, Mateen AA, Naidu MU, Raju YS, Chandra N. Effect of NCB-02, atorvastatin and placebo on endothelial function, oxidative stress and inflammatory markers in patients with type 2 diabetes mellitus: a randomized, parallel-group, placebo-controlled, 8-week study. Drugs RD 2008;9(4):243–50.10.2165/00126839-200809040-00004Search in Google Scholar

24. Gupta I, Parihar A, Malhotra P, Singh GB, Ludtke R, Safayhi H, et al. Effects of boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res 1997;2(1):37–43.Search in Google Scholar

25. Gupta I, Parihar A, Malhotra P, Gupta S, Ludtke R, Safayhi H, et al. Effects of gum resin of Boswellia serrata in patients with chronic colitis. Planta Med 2001;67(5):391–95.10.1055/s-2001-15802Search in Google Scholar

26. Madisch A, Miehlke S, Eichele O, Mrwa J, Bethke B, Kuhlisch E, et al. Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial. Int J Colorectal Dis 2007;22(12):1445–51. doi:10.1007/s00384–007–0364–110.1007/s00384-007-0364-1Search in Google Scholar

27. Sengupta K, Alluri KV, Satish AR, Mishra S, Golakoti T, Sarma KV, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther 2008;10(4):R85. doi:10.1186/ar246110.1186/ar2461Search in Google Scholar

28. Bayrak O, Uz E, Bayrak R, Turgut F, Atmaca AF, Sahin S, et al. Curcumin protects against ischemia/reperfusion injury in rat kidneys. World J Urol 2008;26(3):285–91. doi:10.1007/s00345–008–0253–410.1007/s00345-008-0253-4Search in Google Scholar

29. Rafiee P, Nelson VM, Manley S, Wellner M, Floer M, Binion DG, et al. Effect of curcumin on acidic pH-induced expression of IL-6 and IL-8 in human esophageal epithelial cells (HET-1A): role of PKC, MAPKs, and NF-kappaB. Am J Physiol Gastrointest Liver Physiol 2009;296(2):G388–G398. doi:10.1152/ajpgi.90428.200810.1152/ajpgi.90428.2008Search in Google Scholar

30. Jasti S, Siega-Riz AM, Cogswell ME, Hartzema AG, Bentley ME. Pill count adherence to prenatal multivitamin/mineral supplement use among low-income women. J Nutr 2005;135(5):1093–101.10.1093/jn/135.5.1093Search in Google Scholar

31. Lee JY, Greene PG, Douglas M, Grim C, Kirk KA, Kusek JW, et al. Appointment attendance, pill counts, and achievement of goal blood pressure in the African American study of kidney disease and hypertension pilot study. Control Clin Trials 1996;17(4 Suppl):34S-39S.10.1016/S0197-2456(97)82680-3Search in Google Scholar

32. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1–S266.Search in Google Scholar

33. Chan MM. Inhibition of tumor necrosis factor by curcumin, a phytochemical. Biochem Pharmacol 1995;49(11):1551–6.10.1016/0006-2952(95)00171-USearch in Google Scholar

34. Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee – a randomized double blind placebo controlled trial. Phytomed Int J Phytotherap Phytopharmacol 2003;10(1):3–7.10.1078/094471103321648593Search in Google Scholar

35. Cuaz-Perolin C, Billiet L, Bauge E, Copin C, Scott-Algara D, Genze F, et al. Antiinflammatory and antiatherogenic effects of the NF-kappaB inhibitor acetyl-11-keto-beta-boswellic acid in LPS-challenged ApoE-/- mice. Arterioscler Thromb Vasc Biol 2008;28(2):272–277. doi:10.1161/ATVBAHA.107.15560610.1161/ATVBAHA.107.155606Search in Google Scholar

36. Gayathri B, Manjula N, Vinaykumar KS, Lakshmi BS, Balakrishnan A. Pure compound from Boswellia serrata extract exhibits anti-inflammatory property in human PBMCs and mouse macrophages through inhibition of TNFalpha, IL-1beta, NO and MAP kinases. Int Immunopharmacol 2007;7(4):473–82. doi:10.1016/j.intimp.2006.12.00310.1016/j.intimp.2006.12.003Search in Google Scholar

37. Mezzano S, Aros C, Droguett A, Burgos ME, Ardiles L, Flores C, et al. NF-kappaB activation and overexpression of regulated genes in human diabetic nephropathy. Nephrol Dial Transplant 2004;19(10):2505–12. doi:10.1093/ndt/gfh20710.1093/ndt/gfh207Search in Google Scholar

38. Banerjee M, Tripathi LM, Srivastava VM, Puri A, Shukla R. Modulation of inflammatory mediators by ibuprofen and curcumin treatment during chronic inflammation in rat. Immunopharmacol Immunotoxicol 2003;25(2):213–24.10.1081/IPH-120020471Search in Google Scholar

39. Sander O, Herborn G, Rau R. Is H15 (resin extract of Boswellia serrata, “incense”) a useful supplement to established drug therapy of chronic polyarthritis? results of a double-blind pilot study. [Ist H15 (Harzextrakt von Boswellia serrata, “Weihrauch”) eine sinnvolle Erganzung zur etablierten medikamentosen Therapie der chronischen Polyarthritis?–Ergebnisse einer doppelblinden Pilotstudie]. Z Rheumatol 1998;57(1):11–6.10.1007/s003930050051Search in Google Scholar

40. Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J 1990;265(3):621–36.10.1042/bj2650621Search in Google Scholar

41. Yudkin JS, Kumari M, Humphries SE, Mohamed-Ali V. Inflammation, obesity, stress and coronary heart disease: Is interleukin-6 the link? Atherosclerosis 2000;148(2):209–14.10.1016/S0021-9150(99)00463-3Search in Google Scholar

42. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. New Engl J Med 1997;336(14):973–9. doi:10.1056/NEJM19970403336140110.1056/NEJM199704033361401Search in Google Scholar PubMed

43. Naesh O. Back to the future: postoperative pain management beyond COX-2 inhibitors. N Z Med J 2006;119(1242):U2170.Search in Google Scholar

44. Avissar N, Ornt DB, Yagil Y, Horowitz S, Watkins RH, Kerl EA, et al. Human kidney proximal tubules are the main source of plasma glutathione peroxidase. Am J Physiol 1994;266(2 Pt 1):C367–C375.10.1152/ajpcell.1994.266.2.C367Search in Google Scholar PubMed

45. Venkatesan N, Punithavathi D, Arumugam V. Curcumin prevents adriamycin nephrotoxicity in rats. Br J Pharmacol 2000;129(2):231–4. doi:10.1038/sj.bjp.070306710.1038/sj.bjp.0703067Search in Google Scholar PubMed PubMed Central

46. Fernandez-Real JM, Broch M, Vendrell J, Richart C, Ricart W. Interleukin-6 gene polymorphism and lipid abnormalities in healthy subjects. J Clin Endocrinol Metab 2000;85(3):1334–9.10.1210/jcem.85.3.6555Search in Google Scholar PubMed

47. Stenvinkel P, Ketteler M, Johnson RJ, Lindholm B, Pecoits-Filho R, et al. IL-10, IL-6, and TNF-alpha: central factors in the altered cytokine network of uremia–the good, the bad, and the ugly. Kidney Int 2005;67(4):1216–33. doi:10.1111/j.1523–1755. 2005.00200.xSearch in Google Scholar

48. Richard MJ, Arnaud J, Jurkovitz C, Hachache T, Meftahi H, Laporte F, et al. Trace elements and lipid peroxidation abnormalities in patients with chronic renal failure. Nephron 1991;57(1):10–5.10.1159/000186208Search in Google Scholar PubMed

49. Hill KE, Burk RF, Lane JM. Effect of selenium depletion and repletion on plasma glutathione and glutathione-dependent enzymes in the rat. J Nutr 1987;117(1):99–104.10.1093/jn/117.1.99Search in Google Scholar PubMed

50. Cohen HJ, Chovaniec ME, Mistretta D, Baker SS. Selenium repletion and glutathione peroxidase–differential effects on plasma and red blood cell enzyme activity. Am J Clin Nutr 1985;41(4):735–47.10.1093/ajcn/41.4.735Search in Google Scholar PubMed

51. Furukawa S, Fujita T, Shimabukuro M, Iwaki M, Yamada Y, Nakajima Y, et al. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest 2004;114(12):1752–61. doi:10.1172/JCI2162510.1172/JCI21625Search in Google Scholar PubMed PubMed Central

52. Robertson RP. Chronic oxidative stress as a central mechanism for glucose toxicity in pancreatic islet beta cells in diabetes. J Biol Chem 2004;279(41):42351–4. doi:10.1074/jbc.R40001920010.1074/jbc.R400019200Search in Google Scholar PubMed

53. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al; American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Hypertension 2003;42(5):1050–65. doi:10.1161/01.HYP.0000102971.85504.7c10.1161/01.HYP.0000102971.85504.7cSearch in Google Scholar PubMed

54. Arici M, Walls J. End-stage renal disease, atherosclerosis, and cardiovascular mortality: Is C-reactive protein the missing link? Kidney Int 2001;59(2):407–14. doi:10.1046/j.1523–1755.2001. 059002407.xSearch in Google Scholar

55. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. New Eng J Med 2004;351(13):1296–305. doi:10.1056/NEJMoa04103110.1056/NEJMoa041031Search in Google Scholar PubMed

56. Kimmel PL, Phillips TM, Simmens SJ, Peterson RA, Weihs KL, Alleyne S, et al. Immunologic function and survival in hemodialysis patients. Kidney Int 1998;54(1):236–44. doi:10.1046/j.1523–1755.1998.00981.x10.1046/j.1523-1755.1998.00981.xSearch in Google Scholar PubMed PubMed Central

57. Pecoits-Filho R, Barany P, Lindholm B, Heimburger O, Stenvinkel P. Interleukin-6 is an independent predictor of mortality in patients starting dialysis treatment. Nephrol Dial Transplant 2002;17(9):1684–8.10.1093/ndt/17.9.1684Search in Google Scholar PubMed

58. Tripepi G, Mallamaci F, Zoccali C. Inflammation markers, adhesion molecules, and all-cause and cardiovascular mortality in patients with ESRD: searching for the best risk marker by multivariate modeling. J Am Soc Nephrol 2005;16(Suppl 1):S83–S88.10.1681/ASN.2004110972Search in Google Scholar

Received: 2011-09-07
Accepted: 2012-05-17
Published Online: 2013-07-01

©2013 by Walter de Gruyter Berlin / Boston

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