Patients with chronic kidney disease are looking for a way to boost kidney function, and those with late stage kidney disease hope to stave off the need for dialysis or a transplant. Even healthy individuals who wish to improve their kidney look to herbal diuretics sold as detox products, to temporarily boost kidney output. Although various interventions can help improve the efficiency of the kidneys, one of the best and often overlooked strategies to help the kidneys is pushing detoxification through the skin.
If the kidneys work at all, the kidneys work hard. Damage to the kidneys is often not apparent until the patient is in an advanced state of kidney disease. With approximately one million nephrons in each kidney, the kidneys can compensate for damage to the parenchymal tissue. The remaining functioning nephrons simply work harder to keep up with the demands of the body. This state of hyperfiltration can go on for years with no overt signs of kidney trouble. It is only when the kidneys reach a breaking point where they cannot work any harder, that the creatinine starts to rise and the body becomes uremic. Patients often attribute a sudden shift in their lab work to causes from the recent past, but generally it is the day to day stress on the kidneys that occurs over the course of years that sets the stage for compromised function.
The uremic products most often considered are creatinine, BUN and uric acid. However, currently there are 4,054 metabolic waste products that have been identified in urine. The Canadian government has sponsored the Human Urine Metabolome which is yielding new insights into the chemical composition of urine as well as what urine compounds are associated with specific disease states.1
These uremic waste products also come through the skin. Skin lesions are often the first sign of systemic disease with renal involvement such as amyloidosis and porphyria.2 Patients who suffer severe burns over large portions of the body often experience kidney failure. The waste products that were once eliminated through the skin, now have to be processed through the kidneys. This extra burden has the potential to overwhelm the kidneys. But it also shows the reciprocal relationship between the skin and the kidneys, and how these detox systems complement each other.3
If one encounters the homeless, one of the first qualities noticed, is that these individuals often smell like urine. This is not necessarily the result of accidents or a weak bladder, but a person does not have access to daily showers cannot remove the uremic wastes that come through the skin every day. We also see the relationship of the skin to the kidneys with the phenomenon of uremic frost, a powdery discharge on the skin, which is typically seen when the BUN levels are around 200.4
This is in line with traditional medicines that emphasized skin detoxification. Many in traditional Chinese medicine refer to the skin as the third kidney. Pioneers in naturopathic medicine also knew the value of skin detoxification with recommendations for extended baths and showers. Baths could be as long as 5 hours, at which time the bath water would be noted to be especially foul making it difficult for the patient to continue. Showers could be as long as 8 hours, an outrageous proposition to many concerned with modern droughts.5
Modern research is yielding new insights into the value of skin detoxification for kidney patients. One German study evaluated the benefit of sweating for stage 4 chronic kidney disease patients. Patients sweated into towels, and the towels were then chemically analyzed for content of uremic waste. Not only were uremic waste products found, but the researchers noted that the more often the patients experienced these sweating sessions, the more uremia came out in each session. The body learns to push this pathway through repeated stimulation.6 Another study found upregulation of urea transporters in the skin and sweat glands of uremic patients compared to normal subjects.7 In fact urea concentrations may be up to 50 times greater in the sweat of uremic subjects when compared to serum concentrations.8
Some in mainstream nephrology have even suggested that skin detox can help bridge the gap if dialysis patients miss a session. Anuric patients on long term dialysis have issues of fluid build up between dialysis sessions as they are unable to create urine. This necessitates fluid restriction, one of the most difficult aspects of life on dialysis. Although the fluid volume of sweat is small, the high salt concentration of sweat does much to help fluid balance. By utilizing the skin to eliminate water and salt, these patients may be able ease up on fluid restriction, which goes a long way to improving quality of life.9
On an ongoing basis, skin detoxification can be an adjunct therapy for those in renal failure. Some uremic waste products are easily eliminated with dialysis such as BUN, and adequacy of dialysis can be measured with URR (urea reduction rate) by comparing the concentration of BUN before and after a session. But this is only one of thousands of uremic waste products. Other uremic wastes, particularly those of low molecular weight such as aluminum, can be hard to remove with dialysis, as these waste products may not be caught on the filter of the dialysis machine. 10
Over time as uremic waste products build up in the body, many patients experience “uremic bronzing”, a yellow-orange tone that occurs as uremic wastes are deposited in the skin. Xerosis and pruritus are also noted with late stage kidney disease.11 Pruritus is often the consequence of build up of serum phosphate.12 In practice, the author works with many late stage chronic kidney disease patients and dialysis patients on skin detox. Often in a short period of time the uremic bronzing resolves and the symptomatic pruritus improves.
Patients and practitioners often have questions on what is the best way to go about skin detoxification for kidney health. The extended bath or shower is often a difficult proposition. Busy patients worried about loss of time with a 3 to 4 hour dialysis session, are not likely to agree to spending several hours in the bath tub each week. Of all of the recommendations the author gives in protocols to kidney patients, skin detoxification, unfortunately is usually the last piece they implement. However, once patients start with this, they do notice that they feel better and continuing is self-reinforcing. For those already on dialysis, a 30 minute session on non-dialysis days is associated with improvements across a wide range of clinical parameters.13
Another added benefit to sweating therapy is an improvement in potassium balance.14 As those in kidney failure are unable to pass potassium out in the urine, serum potassium levels may rise to dangerous levels. The cardiac effects of hyperkalemia is the most immediate threat dialysis patients face. The necessity of a low potassium diet, however, eliminates a wide range of fruits and vegetables from the diet. Many end stage renal disease patients believe they have no choice but to eat processed foods of low nutritional value in order to control potassium. By improving potassium balance these patients may able to adopt healthier eating habits.
While dry brushing is convenient, and moving lymph is a good idea, there is far less transfer through air as through water. Some form of hydrotherapy is usually more effective. Traditional saunas and steam rooms are effective, but often too extreme for kidney patients. The sudden expansion of blood vessels with a very hot temperature may lead to orthostatic hypotension with patients who are on hypertension medications.15 Foot pads or ionic foot baths do not seem to give a substantial results16 possibly due to not including enough surface area for significant skin detox.
Infrared sauna, when available, is often a good option for kidney patients. These units typically use a lower temperature than traditional saunas and have a deeper penetration into the skin. There is a wide variety of IR saunas available. Patients who invest in a home unit have the option of doing a 15 minute sauna daily. Frequency of sessions may be even more important than duration as uremic wastes are generated 24/7. Some portable home IR saunas are more energy efficient than others, which can be a consideration over time. Also units with the heating element throughout are preferred over those that have discreet panels and only detoxify the area of skin directly in front of the panel. Some units also heat almost instantly, a big advantage over those that can take an hour to warm up. These convenience factors are a big consideration if one is to make IR sauna a part of the every day routine.
The cardiovascular benefits of infrared sauna should also be considered. The cause of mortality for most renal patients is not renal failure but secondary heart disease. Thermal therapy, which includes water immersion, traditional sauna and infrared sauna, was found to improve several parameters of cardiac health including: endothelial function, hemodynamics, cardiac geometry, neurohormonal markers, and quality of life.17
If IR sauna is not an option, detox baths may be the next best option. One cup of Epsom salt and two cups of apple cider vinegar in a standard bath tub can help create a draw in the bath water to pull out uremic toxins. (Bentonite clay is also useful, but one must consider that it can hard on plumbing and difficult to drain.) The Epsom salt/ apple cider vinegar combination has proved clinically useful and the feedback from uremic patients has noted a significant improvement with uremic bronzing. 20 minutes in the tub a few times a week is often all it takes. Patients would do well to scrub the skin and aim to maximize the surface area in the tub, submerging the upper body as much as possible. Some patients are concerned with the smell of apple cider vinegar staying with them after the detox bath. This is usually not a problem but a quick shower after the bath will take care of any issue.
Another type of bath that can be helpful for kidney support is the salt bath. This type of bath uses 2 of the 1 lb. boxes of regular table salt. This makes the water especially salty, like seawater, and creates an osmotic gradient that can be helpful for skin detoxification. The salt bath is especially warming. Usually after a hot bath, a person feels chilled stepping out into the cooler air. A hot salt bath is deeply warming and closes the pores of the skin so that the heat stays with the person. TCM associates kidney chi with body heat 18, and many with kidney failure have a chronically low body temperature.19 For these patients regular salt baths are especially helpful with cold and damp weather conditions.
Detox baths and salt baths can be used for patients at all stages of kidney disease. With diabetics it is advisable to caution them to check the temperature of the water and make sure that it is not above 1040F. Post-transplant patients should only have a warm bath and not a hot bath, as the high temperature acts like a fever, stimulating the immune response.20 Those with a transplanted kidney should also avoid infrared sauna as this also is too immune stimulating.
The benefits of skin detox happen over time with repeated sessions. Evidence from hair analysis indicates that it may take several months to clear aluminum and lead. Arsenic may clear even more slowly.21 Patients often report feeling better shortly after beginning a skin detox protocol but they should be aware that this can be a long term process.
In conclusion skin detoxification is an especially useful approach for kidney patients or anyone interested in maintaining good kidney health. Rather than look to diuretics which push the kidneys to work harder, skin detoxification helps reduce the stress on the kidneys. By reducing the workload, therapeutic baths and saunas offer support for chronically overworked kidneys.
References:
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