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March 10, 2024

Cannabis and kidney disease: A Comprehensive Guide for Patients

Cannabis and kidney disease
Photo by Tânia Mousinho on Unsplash

Introduction

Living with chronic kidney disease (CKD) and undergoing dialysis treatments can be a challenging and overwhelming experience. Patients often seek alternative therapies to manage their symptoms and improve their quality of life. In recent years, there has been growing interest in the use of cannabis and cannabinoids as potential therapeutic options for CKD patients. Cannabis and kidney disease have a complicated relationship. This guide aims to provide a comprehensive overview of cannabis and its potential benefits and risks for individuals undergoing dialysis.

Understanding Cannabis and Cannabinoids

Cannabis, also known as marijuana, weed, pot, or ganja, is the most commonly used illicit drug in the United States. It is derived from the dried flower buds of the Cannabis sativa and Cannabis indica plants. Cannabis contains numerous compounds called phytocannabinoids, with the most well-known being delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). These phytocannabinoids interact with cannabinoid receptors in the body, known as CB1 and CB2 receptors, and have varying effects on the body.

THC is the primary psychoactive component of cannabis and is responsible for the "high" sensation often associated with marijuana use. CBD, on the other hand, is non-intoxicating and has gained popularity for its potential therapeutic benefits in treating various medical conditions. It is important to note that cannabis strains can have different ratios of THC to CBD, which can influence their effects on the body.

Symptoms Associated with CKD and ESRD

CKD and end-stage renal disease (ESRD) can cause a range of symptoms, including pain, nausea, anorexia, sleep disturbance, anxiety, and depression. Many of these symptoms are approved indications for medical cannabis in certain states. For instance, chronic pain is a prevalent issue among CKD patients, with up to 50% experiencing pain. Cannabis has been recommended historically as a spasmolytic for renal colic and for facilitating the excretion of small kidney stones.

Research suggests that cannabis may have medicinal benefits in treating symptoms associated with advanced CKD and ESRD. It has been found to potentially reduce the need for opioids as a pain adjuvant, which is particularly relevant given the high prevalence of opioid prescriptions among dialysis patients. However, further research is needed to determine the optimal dosing and efficacy of cannabis in managing these symptoms.

Cannabis and kidney disease

One concern for individuals with impaired kidney function is the potential impact of cannabis use on kidney health. While cannabis does not seem to affect kidney function in healthy individuals, it is important to closely monitor renal function in those with CKD. The lowest effective dose should be used, and smoking should be avoided due to potential pulmonary complications.

Studies evaluating the association between cannabis use and CKD progression have yielded mixed results. Some studies have found an association between chronic cannabis usage and more rapid decline in estimated glomerular filtration rate (eGFR), while others have not demonstrated a significant relationship. More research is needed to fully understand the impact of cannabis use on kidney function in CKD patients.

Acute Kidney Injury and Synthetic Cannabinoids

Synthetic cannabinoids, also known as "spice" or "K2," are potent CB1 agonists initially developed as research compounds but have emerged as popular recreational drugs. These synthetic cannabinoids have been linked to cases of acute kidney injury (AKI), with a compound called XLR-11 identified as a potential nephrotoxic substance. Symptoms of AKI associated with synthetic cannabinoids include nausea, vomiting, and flank pain.

Kidney Transplantation and Cannabis Use

Cannabis use can have implications for kidney transplantation. Cannabis abuse and dependence may be associated with a high prevalence of other substance use disorders, psychiatric comorbidities, and strong family histories of addiction. Some transplant centers have policies in place that vary regarding the acceptance of potential transplant candidates who use cannabis. It is important for individuals considering kidney transplantation to discuss their cannabis use with their healthcare providers to ensure appropriate evaluation and management.

Medical Risks and Complications

The use of cannabis, particularly smoking, is associated with increased mortality among individuals with CKD and ESRD. Smoking cannabis can cause respiratory complications, including bronchial irritation and chronic bronchitis. Regular heavy cannabis use, however, has been associated with a lower risk of pulmonary complications compared to tobacco use. It is recommended that individuals with cardiovascular or pulmonary disease avoid smoking cannabis and consider alternative routes of administration, such as oral consumption.

Cannabis use can also have cognitive effects, including sedation and impairment of memory and attention. Acute and long-term cannabis use may impair cognitive function, particularly in tasks related to learning and memory. However, the evidence regarding the impact of cannabis on cognitive function is inconsistent, and more research is needed to fully understand these effects.

Marijuana and fluid gain on dialysis

Marijuana use among individuals undergoing dialysis treatment has been a subject of increasing concern in recent years. Dialysis is a medical procedure that helps filter waste and excess fluid from the blood when the kidneys are no longer able to perform this function adequately. Fluid gain, or the accumulation of excess fluid in the body, is a common complication experienced by dialysis patients. It is important to understand the potential impact of marijuana use on fluid gain in order to ensure the best possible outcomes for these individuals.

While research on the specific relationship between marijuana use and fluid gain on dialysis is limited, there are some factors that suggest a potential link. Marijuana use has been associated with increased thirst and appetite, which may result in higher fluid intake and subsequently contribute to fluid gain. In conclusion, while the specific impact of marijuana use on fluid gain in dialysis patients remains unclear, there are factors that suggest a potential relationship.

Marijuana and phosphorus level in kidney patients

Recent studies have shown a concerning link between marijuana use and an increase in phosphorus levels among kidney patients. Phosphorus is an essential mineral that plays a crucial role in maintaining bone health and the proper functioning of various bodily systems. However, elevated levels of phosphorus can lead to complications, particularly in individuals with pre-existing kidney conditions. The exact mechanism by which marijuana use affects phosphorus levels is still not fully understood, but it is believed that certain compounds present in the drug may disrupt the normal balance of phosphorus in the body. Marijuana use also is associated with increased appetite which can lead to unhealthy eating habits especially in patients on dialysis and cause elevated phosphorus level

Conclusion

In summary, Cannabis and kidney disease have gained interest as potential therapeutic options for individuals with CKD and undergoing dialysis. While cannabis may have medicinal benefits in managing symptoms associated with CKD and ESRD, there are important considerations regarding impaired kidney function, acute kidney injury, kidney transplantation, and potential medical risks and complications. It is crucial for patients to have open and honest conversations with their healthcare providers about their cannabis use and to consider alternative treatment options when appropriate.

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