Table 4.
Summary of evidence for cannabinoid effect on symptoms associated with kidney failure
| Symptom | Potential Mechanism | Evidence in Non-CKD Population | Study Details | Evidence in CKD Population |
|---|---|---|---|---|
| Restless legs syndrome | CB1 found throughout the central nervous system Cannabinoids modulate dopaminergic and GABAergic signaling (37,39,40) | Patients with RLS: Symptom relief with smoked marijuana or sublingual CBD (41,42) | Two case series (same center), total n=18 | Nil |
| Pruritus | Inhibition of TRPV1 (46) Reduced production of inflammatory cytokines (44) | Nil | Nonrandomized study, n=21 | Hemodialysis patients: uncontrolled prospective study (n=21) found that an endocannabinoid-containing emollient was effective (51) |
| Insomnia | THC has sedating properties, possibly mitigated by CBD (54) | Patients with insomnia associated with fibromyalgia: Nabilone superior to amitriptyline (108) | Randomized, double-blinded, crossover trial, n=31 | Nil |
| Anorexia | Activation of central CB1, resulting in appetite stimulation and shift of white and brown adipocytes to anabolic state (58–60) | (a) Patients with HIV-associated cachexia and anorexia nervosa: Modest efficacy with smoked cannabis and dronabinol (61–64) (b) Patients with cancer-related anorexia: Mixed results (65,66) | (a) Four RCTs, total n=204 (b) Two RCTs, total n=290 | Nil |
| Pain | Actions on diverse range of neuronal ion-channels and receptors, including α-3 glycine receptors, 5HT1a receptors, and TRPV1 (68,74,75) | Patients with chronic non-cancer pain and neuropathic pain: Modest efficacy (69,78) | Two meta-analyses: 104 studies (47 RCTs, 57 observational), n=9958; 16 double-blind RCTs, n=1750 | Nil |
| Nausea | Modulation of CB2 in the enteric nervous system, resulting in a reduction of enterotoxin-mediated gut motility (85) Potential action via central CB1 | Patients with CINV: Nabilone, dronabinol and THC:CBD modestly effective (83,84) | Meta-analysis: 23 RCTs, n=1359; one further RCT, n=81 | Nil |
CB, cannabinoid receptor; GABA, gamma-aminobutyric acid; RLS, restless legs syndrome; CBD, cannabidiol; TRPV1, transient receptor potential cation channel subfamily V member 1; RCT, randomized controlled trial; 5HT1a, 5-hydroxytryptamine 1a; CINV, chemotherapy-induced nausea and vomiting; THC, tetrahydrocannabinol.