Table 3.

Summary of Evidence of Nonsynthetic Cannabinoids for Symptom Management in CKD.

Indication	Level of evidencea	Conclusion
Chronic pain	1a	• Based on extrapolated evidence from patients without renal impairment, nonsynthetic cannabinoids have a moderate effect on the reduction of chronic neuropathic pain, which is a minimum of 30% pain reduction.53,56,57,60
Nausea and vomiting	—	• There is a lack of evidence to support or disprove the use of nonsynthetic cannabinoids for uremia-induced nausea and vomiting, as cannabinoids have not been studied for this indication.
	2b	• Based on limited evidence extrapolated from patients without renal impairment, nonsynthetic cannabinoids may possibly be effective in the treatment of chemotherapy-induced nausea and vomiting secondary to low-to-moderate emetogenic chemotherapy regimens.67-69
	1a	• Based on extrapolated evidence from patients without renal impairment and receiving moderate to highly emetogenic chemotherapy regimens, synthetic cannabinoids, nabilone, and dronabinolb have comparable efficacy with prochlorperazine and metoclopramide for the treatment of chemotherapy-induced nausea and vomiting, but with higher incidences of adverse effects.66
Anorexia	—	• There is a lack of evidence to support or disprove the use of nonsynthetic cannabinoids as appetite stimulants in uremia-induced anorexia and cachexia due to an absence of studies for this indication.
	2b	• In extrapolated data from patients without renal impairment with HIV-associated wasting syndrome, there is limited evidence that nonsynthetic cannabinoids are effective in increasing caloric intake and body weight in the short term.76-78
	1b	• In extrapolated data from patients without renal impairment, nonsynthetic cannabinoids are ineffective for increasing appetite or improving quality of life in cancer-related anorexia-cachexia syndrome.75
	—	• There is a lack of evidence to support or disprove the use of nonsynthetic cannabinoids as appetite stimulants in patients with anorexia nervosa, as they have not been studied for this indication.
Uremic pruritus	2b	• Topical endocannabinoids may possibly be effective for uremic pruritus in patients receiving hemodialysis based on limited evidence from a small observational study.84
Insomnia	—	• There is currently a lack of evidence to support or disprove the use of nonsynthetic cannabinoids for insomnia, as studies have not been conducted in patients with primary insomnia.

Note. CKD = chronic kidney disease.

^aBased on the Oxford Centre for Evidence-based Medicine Grading.

^bDronabinol has been discontinued in Canada, but is approved for use in the United States.