Kidney toxicity

In the early 1950s several deaths occurred from nephrotoxicity after EDTA treatment. At that time the dosage used was around 10 grams per infusion, whereas the recommended dose now adays is 3 grams.

Halstead (1979) states:

The problem in EDTA nephrotoxicity is based upon two fundamental principles of toxicology: dosage and route of administration. Dosage is concerned with both the amount administered and the rate of administration, or the time period in which the EDTA is given.

It appears that toxicity for the kidneys may relate directly to too large a dose infused at too fast a rate. In general, if no more than 3 grams is infused in any 24­hour period (diluted with 500 ml sterile Lactated Ringer's solution or-except in the case of diabetes-5 per cent dextrose solution), with a 24­hour rest period between chelation infusions (2­3 per week) and if the infusion of these 3 grams (less than 50 milligrams per kilo of body weight) is timed to take around three hours, little if any danger exists of producing toxicity for the kidneys.

Indeed, research has shown that in general chelation therapy improves kidney function, particularly if any impairment to these vital organs relates to circulatory problems.

Improved kidney function after EDTA

McDonagh, Rudolph and Cheraskin (1982d) have investigated the alleged toxicity of EDTA in relation to kidney function and their results are worth some consideration.

They examined the results of treating 383 people with a variety of chronic degenerative disorders (primarily occlusive arterial disease) with EDTA chelation therapy (plus supportive multivitamin/mineral supplementation) for 50 days.

The measurement of the levels of creatinine in the blood is commonly used in medicine as a guide to kidney efficiency.

Creatinine is the end breakdown product of muscle activity which is cleared from the body by filtration through the normal kidney. The levels found in the bloodstream are known to correlate well with the rate and efficiency of clearance, giving a simple way of judging kidney function. The researchers made specific measurements of the levels of creatinine in the blood of these patients at the first visit (fasting levels) and then gave 10 infusions of 3 grams of EDTA in a solution of 1000 cc normal saline with an interval of five days between each infusion (supplementation was also given). After this the serum creatinine was again assessed.

They found that a very interesting balancing effect could be seen when the overall picture was revealed, very similar to that noted when cholesterol ratios were examined (see Chapter 4). Those people who initially had low levels of serum creatinine showed a very slight increase; those in the mid­range (normal?) showed no change and those above the mid­range of normal and actually with a creatinine excess (therefore indicating poor clearance by the kidneys) showed a drop towards normal.

Overall the total measurement showed an average decline in serum levels (indicating improved kidney function), but far more significant, according to the judgement of the researchers, is the homoeostatic effect in which ­ whether high or low to start with ­ a tendency towards the mid­range (between 0.5 and 1.7 milligrams/decilitre) is observed.

It seems that EDTA therapy may actually improve kidney function if it is applied slowly with normal dosages.

One exception
These researchers make note of one exceptional case amongst nearly 400 patients tested in this way, and the progression of events is worth noting as an example which highlights both the initial concerns which some patients might produce and the long­term benefits of chelation therapy.

This was an 86­year­old female in whom the initial measurement of creatinine was 1.9 mg/dl, which is regarded as abnormally high and therefore indicative of poor kidney function. After starting chelation every five days, a rise was seen in the creatinine levels by day 25 (fifth infusion) to a very unhealthy 3.5 mg/dl. As treatment progressed, it dropped to 2.8 mg/dl by day 60 and had dropped to 1.8 mg/dl by day 100, some time after the course of chelation therapy had finished.

As the researchers point out: 'this emphasizes the need to follow renal function during EDTA therapy, and, one might add, for a while after, as the benefits frequently are not fully manifest before about three months after treatment is over.

Special considerations: age, heavy metals or parathyroid deficiency

If the patient is very elderly, or has low parathyroid activity or is suffering from heavy metal toxicity which is damaging kidney tubules, treatment should be modified to use less EDTA less frequently (once weekly perhaps). Heavy metals damage the kidneys and too rapid infusion can overload them. Heavy metals most likely to produce kidney damage during infusion therapy (if this is done too rapidly, that is) are lead, aluminium, cadmium, mercury, nickel, copper and arsenic.

Renal function tests should always be performed before chelation therapy is started in which serum nitrogen (BUN) and serum creatinine is examined. In any case of significant renal impairment, lower dosage EDTA infusions should be used with extreme caution with suitable periods of rest between.

Too much calcium removed

If, through inexperience or error, there is too rapid an infusion (or too much EDTA used), levels of calcium in the blood can drop rapidly, resulting in cramps, tetany, convulsions, etc. An injection of calcium gluconate will swiftly control such abnormal reactions. This hypocalcaemia reaction is almost unheard of where the guidelines given above are followed as to dosage, speed of infusion and spread of treatments.

Inflammation of a vein

If an infusion into a vein is performed too rapidly, inflammation may occur (thrombophlebitis). This is unlikely in the extreme if guidelines as described above are followed concerning dilution of EDTA with Ringers solution or dextrose solution and slow infusion.

Should the needle carrying the infusion slip, a local soft tissue irritation may develop. This may best be treated with use of alternate hot and cold packs. Supplementation with antioxidant nutrients such as vitamins C and E (make sure of a good source) and the mineral selenium should protect against such an incident.

Care regarding insulin shock and hypoglycaemia

During EDTA infusion it is possible for blood glucose to drop, leading to insulin shock. This is more likely amongst diabetics in whom no dextrose solution should be used. Patients having EDTA infusions are advised to have a snack before or during the three hours plus treatment period. Walker and Gordon (1982) recommend the following strategy:

You should eat something before the three to four hour infusions, but not high­calcium­containing foods such as dairy products. Rather, eat adequate unrefined complex carbohydrates and avoid most sugars, including overripe bananas.

During an infusion they recommend eating fruit.

In diabetic individuals, using zinc­bound insulin involves a risk of too rapid a release of insulin, leading to hypoglycaemia and shock. A rapid introduction of sugar is needed in such an instance and a change in the form of insulin used before further EDTA infusions are tried. Most people with known diabetes find that with chelation therapy their requirement for insulin declines.

Congestive heart failure

If the heart is already unable to cope adequately with movement of fluids, and there is evidence of congestive heart failure (extreme shortness of breath, swollen ankles) and/or if digitalis­like medication is being taken, extreme care is needed over chelation infusions, since EDTA prevents digitalis working adequately. Sodium EDTA would appear to be undesirable in such people as it could increase the fluid retention tendency. However, Halstead is adamant that:

Na2 EDTA does not appear to have any significant deleterious effects in congestive heart patients since the sodium (Na2) is apparently excreted intact with the metal chelate. However, the use of 5 per cent dextrose and water is recommended in such cases.

Short­term side­effects

A number of variable side­effects have been observed with use of intravenous EDTA infusion, including the following:

• Headaches ­ which often relate to the same phenomenon discussed above, of low blood sugar. Eating before treatment, or during it, will usually prevent this possibility. It is reported that a common recommendation which prevents 'EDTA­headaches' is that a banana, not overripe, be eaten during the first hour of infusion.
• Diarrhoca ­ this unusual side­effect should be treated with rest and a bland diet with plenty of liquids for a day or so. Urinary frequency is common as kidney efficiency improves and a weight loss (from fluid excretion) of 3­5 pounds (1.3­2.2 kg) is common after an infusion if fluid retention was previously evident.
• Local skin irritation may result and is usually associated with a reduction in zinc and vitamin B6 (pyridoxine). For this reason supplementation of these nutrients is usually suggested during chelation therapy.
• Nausea or stomach upset may also be related to vitamin B6 deficiency in the less than one patient in 100 receiving chelation therapy who feels this side­effect. It is best treated by B6 supplementation, although short­term relief (up to eight hours) from nausea can be achieved by applying thumb pressure to a point two thumb­widths above the wrist crease on either forearm (acupuncture point P6) for a minute or so whenever the symptom is felt.
• Feeling faint may relate to a drop in blood pressure. It is common for those who start treatment with high blood pressure to see a return to more normal levels. If it were normal to start with, it could drop slightly as well as leading to feelings of faintness on standing after sitting or lying. Treatment is to rest for an hour or so when this happens, ideally with the feet slightly higher than the head. The amino acid tyrosine can safely be supplemented to help restore normal pressure levels if this symptom persists.
• Fever may develop in a very few people during the day after chelation therapy sessions (approximately one in 5000). Whoever is in charge of the treatment should be told, although the condition normally resolves on its own.
• Extreme fatigue may be felt in some people and this is usually the result of a general nutrient deficiency in minerals such as magnesium, zinc or potassium. Taking a potassium­rich supplement and/or the regular eating of potassium­rich foods is suggested before and during chelation (grapes, bananas, peaches, potato skins), as this mineral may be removed by the process itself.
• Pains in the joints are more likely where infusions are frequent (three weekly). An immediate reduction to once weekly is suggested, and also possibly a reduction in dosage of EDTA being used, if strong flu­like aches develop. The symptoms should pass fairly soon if these strategies are adopted.
• Cramps in the legs are not uncommon (one patient in 20), usually at night. The supplementation of magnesium (either by mouth or in the El)TA infusions) will usually prevent this happening. If it is added to the infusion this could be in the form of magnesium chloride or magnesium sulphate. Such additions also reduce the chance of local skin irritation at the site of the infusion.