The scope and opportunity with regard to the use of Cannabis in kidney disease has been debated for some time. 

However, the paradox of Cannabis is that it is a widely used illicit drug in the United States and known by names such as marijuana, pot, weed, Mary Jane, reefer, the devil’s lettuce, loco weed and ganja.

Marijuana is also a federally banned substance although many states have liberalized their laws to facilitate medical use, leisure use, and decriminalized laws governing its possession and use.

This dried flower bud of Cannabis indica plants has a high content of Phytocannabinoids including Tetrahydrocannabinol (THC) and Cannabidiol (CBD) called as Phytocannabinoids. 

Many studies have been looking into the prospects of using cannabis and derivative cannabinoids in treating patients afflicted with kidney-related issues.

Studies have indicated that Cannabis contains more than 200 phytocannabinoids, flavonoids, and terpenoids. They collectively provide an entourage effect and reinforce more than the efficacy of the individually isolated compounds. 

The Plight of People With Chronic Kidney Disease

In the U.S, there are more than 1.5 million people with advanced CKD (Chronic Kidney Disease) and 750 000 people suffering from end-stage renal disease (ESRD). 

Nearly half of such patients with CKD undergo chronic pain, nausea, depression, anxiety, anorexia, and sleep disturbance. Most of these are approved indications for medical cannabis. 

Many people also use cannabis for self-treating anxiety, depression, and insomnia. The dilemma is that the legalization of cannabis by many states still stands in conflict with federal laws where it is a Schedule I controlled substance without medical use and concerns over its potential abuse. 

This is despite the World Health Organization rejecting any abuse potential of CBD. Also, no evidence exists that CBD has any adverse effect on kidney function. A mouse model has offered positive evidence that CBD can reduce oxidative stress and prevent cisplatin-induced nephrotoxicity. 

Cannabis Can Have A Role In Pain Alleviation 

The scope for Cannabis-based treatment of CKD at symptomatic and advanced stages as a pain alleviator reducing opioid applications has been taken note of. 

Many CBD based pharmaceuticals are already in vogue mainly as oral potions with the legal stamp of the regulator U.S. Food and Drug Administration (FDA) treating many medical issues. 

The examples include Epidiolex for pediatric epilepsy. Synthetic THC Dronabinol in Marinol, Syndros, and Nabilone with a synthetic THC analog.  Cannabis extract Nabiximols is allowed for use outside the United States.

Although there is no evidence that Cannabis causes any harm to the kidneys of healthy individuals, considering the the gravity of CKD the lowest dose is advised and ideally it shouldn’t be smoked.  

Widespread use of Cannabis CBD

Already the use of Cannabidiol (CBD) has grown exponentially and has pervaded to neurological and psychiatric conditions. In the meantime, consumers have expanded access to many unregulated CBD products in which many are flaunting false health claims and misguiding with inaccurate labeling.  One concern with CBD has been that it may raise Tacrolimus levels. An anti-rejection medication for kidney transplants.

Barriers of Cannabis In CKD Treatment

Now the main barriers blocking the usage of cannabis in renal treatments are lack of guidance to patients and doctors by a knowledge gap from the federal regulations that are hampering the prospective research.

The existing federal curbs against cannabis use are borne by the age-old Marijuana Tax Act and the Controlled Substances Act constraining the research and medical education about the drug. 

In the U.S, the scenario is that 33 states and the District of Columbia have legally permitted medical cannabis programs as of December 2019. The recreational use of marijuana has been allowed in 11 states plus the District of Columbia. A truncated usage pattern of cannabis exists. 

At the same time, cannabis use in the U.S has more than doubled among patient groups since the new millennium especially between 2001 and 2013. 

Demographically, these user groups are in the 50 plus and 65 plus age brackets. They face many chronic illnesses including CKD high on morbidity and death. 

More Pro Cannabis Arguments

Researchers believe that the endocannabinoid system covering renal tissues could positively respond to cannabis impact on mattters like renal blood flow, fibrosis, glomerular filtration rate, proteinuria, and tubular functions. 

The endocannabinoid system or ECS is composed of endocannabinoids that are essential neurotransmitters bound to cannabinoid receptors (CBRs), and receptor proteins in the peripheral nervous system and brain. 

The ECS has a big role in regulating many cognitive and physiological processes including the mediation of the pharmacological effects of cannabis. However, physicians are still in dark about the impact cannabis can exert in the ECS system. 

An obvious role for cannabis as therapeutic pain management in renal treatment is looking imperative. The pain management agent’s role needs clinical consideration and trial investigation. 

There is data showing that the use of medical cannabis has historically led to decreased opioid prescriptions and dose reductions.
Opioid use has been rampant among renal patients. More than 60 percent of dialysis patients had one opioid prescription annually.

Similarly, 20 percent of patients use prescription opioids. 
Both short-term and long term use of prescription opioids increases the risk of morbidity and mortality. 

Therefore, in line with the expanding market for cannabis, studies need to focus on the long-term effects of chronic and frequent use of cannabis. 

Cannabis is consumed in many ways. There is the smoking method of the dried flower bud or the use of vaporizers that vaporize various cannabinoids without emitting smoke. 

Advice for patients with CKD and ESRD is to avoid smoking cannabis. This is especially important in people from cardiovascular or pulmonary disease. However, oral consumption avoids these risks.

Given the growing acceptance of medical and recreational cannabis and cannabinoids, research into the safety, efficiency, and acceptability of medical and recreational cannabis among people with CKD and ESRD needs more expansion. Clinicians also need more up to date information to guide the patients.

Many unfortunate incidents have followed vaping of electronic cigarettes and vape pens because illicit manufacturers placed dubious chemical irritants including oil diluents like vitamin E acetate in the THC oil concentrates.

For consumers, safer use of CBD products involves scrutinizing labels to ensure the product is made with good manufacturing practice and there is an organic certification by the Agriculture Department. 

Also, the purchase of the CBD must be from certified medical dispensaries possessing a certificate of analysis. Those consuming CBD regularly needs to conduct careful monitoring of their clinical parameters.

Article Reference: https://journals.lww.com/co-nephrolhypertens/fulltext/2020/03000/the_nephrologist_s_guide_to_cannabis_and.15.aspx