Ninety-seven patients (mean age, 48 years) with chronic renal failure (serum creatinine > 5 mg/dl), with a history of declining renal function for at least 12 weeks, were randomly assigned to receive, in double-blind fashion, water-soluble coenzyme Q10 (CoQ10; 60 mg, 3 times per day orally) (Q-Gel) or placebo for 12 weeks.
The 45 patients who were receiving hemodialysis at the start of the study were encouraged to decrease the frequency or stop dialysis if there was an increase in urine output and a decrease in serum creatinine of more than 2 mg/dl. In the patients receiving hemodialysis and CoQ10, the mean serum creatinine concentration decreased from 9.5 to 6.7 mg/dl; mean BUN decreased from 88.2 to 79.8 mg/dl; mean creatinine clearance increased from 40 to 54.9 ml/min; and 24-hour urine output increased from 1,300 to 1,920 ml. Renal function tended to worsen in hemodialysis patients receiving placebo, and the differences in the changes between groups were significant (p < 0.01 to p < 0.001).
Significant improvements in each of these parameters relative to the placebo group were also seen in the non-dialysis patients treated with CoQ10. The number of patients receiving dialysis decreased from 21 to 12 in the CoQ10 group, and remained unchanged at 24 in the placebo group (p < 0.02). Eighty-one percent of the patients receiving CoQ10 had a positive response to treatment.
Comment by Alan R. Gaby MD:
These results suggest that hydrosoluble CoenzymeQ10 (Q-Gel) can improve renal function and reduce the need for dialysis in patients with chronic renal failure. The public-health implications of this study are enormous, considering that chronic renal failure is a serious and debilitating disease and that the annual cost of dialysis in the United States is more than $22 billion.
According to Dr. Singh, lead author of this study (Interview with Kirk Hamilton; Clinical Pearls News, August, 2001, pp. 128-9), CoQ10 is usually effective if pre-treatment urine output, with or without furosemide, is at least 1,000 ml/day. However, if urine output is less than 500 ml/day, then CoQ10 usually does not work, presumably because the kidney has been irreversibly damaged.
Dr. Singh recommends that all patients with renal failure take 180 mg/day of water-soluble CoQ10 (Q-Gel) if their urine output is greater than 500 ml/day on dialysis. If urine output increases to 1,000 ml/day within 12 weeks, then CoQ10 is likely to be effective. Patients should be able to stop dialysis within 12-48 weeks if the urine output goes above 1,500 ml/day. If urine output does not increase in 12 weeks, then CoQ10 is unlikely to be effective.
While the mechanism by which CoQ10 improves renal function is not clear, it may work by improving cellular bioenergetics. Large controlled trials are urgently needed.
[Thus we hypothesize that using the full Metabolic Optimizer protocol with Ubiquinol instead of standard CoQ10 may have an even greater effect.]
Comment by LEF
In a randomized, double-blind, placebo-controlled trial, the researchers found CoQ10 treatment decreased progression and reversed renal dysfunction in a majority of patients with end-stage disease, many of whom were able to discontinue dialysis over the course of the 12-week trial. The report followed up on a pilot study the scientists published in 2000 involving a smaller number of subjects.
End-stage kidney disease produces marked organ contraction and progressive dysfunction, with corresponding increases in levels of serum creatinine and blood urea nitrogen. Levels of toxic waste products accumulate in the blood because the kidneys cannot clear them from the body.
Dr. Singh and his colleagues documented significantly lower levels of serum creatinine and blood urea nitrogen in the CoQ10-treated patients, with increases in creatinine clearance and urine output regardless of patient dialysis or baseline status. More significantly, only half the number of CoQ10 patients required dialysis at the end of the study when compared to subjects receiving placebo.
The researchers also reported considerable increases in the antioxidant vitamins E and C and beta-carotene in treated subjects, while plasma levels of oxidative stress such as thiobarbituric acid reactive substances, diene conjugates, and malondialdehyde all fell dramatically.
Although one in five patients did not respond, the researchers concluded that CoQ10 Q-Gel supplementation improves renal function in end-stage patients regardless of dialysis status, and can delay or avert the need for dialysis. They suggested that higher doses than those used in their study (180 mg per day) might result in even greater improvement and response in others.
Singh RB, et al. Randomized, double-blind, placebo-controlled trial of coenzyme CoQ10 in patients with end-stage renal failure. J Nutr Environ Med 2003;13:13-22.
Reprinted with exclusive permission of TOWNSEND LETTER for DOCTORS and PATIENTS - OCTOBER 2005.
Reprinted with exclusive permission of LEF - Aug 2004.