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Can Cannabinoids Treat Kidney Diseases?

Kidney disease affects 800 million people globally and it’s one of the first causes of death. Physicians prescribe opioids to help patients manage their pain, but cannabis might become a safer alternative. Research is still ongoing, and THC and CBD may be able to help with some renal conditions.

We usually don’t think too much about our kidneys, despite the hard job they do for us, cleaning our blood by removing toxins and waste materials. Genetic issues, injuries, some medicines or other factors can lead to kidney diseases that prevent these organs from functioning correctly. Common kidney problems are chronic kidney disease or acute kidney injury, but also infections, cysts, stones, and cancer. When kidneys fail completely, a dialysis or a kidney transplant are required. In the United States, kidney diseases are the ninth cause of death, which certainly puts them in the spotlight and makes the kidneys and their functioning subjects to various studies.

Research shows that cannabis might become a safer alternative to anti-inflammatory drugs and opioids prescribed to relieve pain in chronic kidney disease. A better understanding of the impact of cannabinoids on the renal system may lead to the development of new drugs that could treat the symptoms of kidney diseases with very little side effects compared to drugs available today.

KIDNEYS AND THE URINARY SYSTEM

The main components of the urinary system are kidneys, ureters, bladder, and the urethra. This system eliminates waste from the body, it contributes to regulating blood volume and blood pressure, controls electrolytes and metabolites, and regulates blood acidity. Kidneys have an intense blood circulation and inside them there are many tiny structures called nephrons, filtering our blood at the pace of half a cup every minute. Urine is formed as a result of this healthy filtration, and is passed to the bladder for a temporary storage. Only a small percentage of filtered blood becomes urine, while the purified water is returned to the blood flow, together with other useful substances. Kidneys constantly clean our blood of toxins, and they also maintain a healthy balance of water and minerals, such as sodium, calcium, phosphorus, and potassium. Finally, they produce hormones which control blood pressure, develop red blood cells and play a role in vitamin D absorption.

Most kidney diseases attack the nephrons. The acute kidney injury (AKI) is a sudden loss of kidney function that is observed over a course of a few days. This disease leads to complications like acidosis, excess of potassium, uremia, and may have dangerous effects on other organs. Mortality after a severe kidney injury remains high.

In chronic kidney disease (CKD) the damage usually happens slowly, over a long period of time, without making the patient feel sick until the condition becomes serious. The most common causes include diabetes and high blood pressure, while complications include heart disease, bone disease, and anaemia. Common symptoms are: leg swelling, vomiting, loss of appetite and energy, or even mental confusion.

THE ENDOCANNABINOID SYSTEM AND KIDNEYS

Cannabinoid receptors CB1 and CB2 are found in various tissues and organs, including the kidneys. Endocannabinoid system regulates cell signalling targets that are vital for energy homeostasis. Experimental studies suggest that cannabinoids could have both beneficial and undesirable effects on the kidneys, depending on the type of renal disease, dosage and other factors. Research hasn’t fully explained how the endocannabinoid system might be involved in the development of renal conditions, or in the healing process. However, unbalanced endocannabinoid production—overactivation on CB1 and inhibition of CB2—appears to play a role in chronic kidney disease. This kind of imbalance is similar to the one happening in obesity and type II diabetes.

VARIABLE RESEARCH RESULTS

A study published in The American Journal of Medicine collected data from 14.000 adults who took part in the US National Health and Nutrition Examination Survey. Researchers checked levels of albumin in urine, which is a marker for kidney diseases, and they found no association between past or current marijuana use and worsened kidney function or disease. That’s good news for sure, yet a research at the Icahn School of Medicine at Mount Sinai in New York studying kidney disease in cannabis users found that chronic kidney disease (CKD) patients had kidney functions declining faster compared to those who did not use cannabis. However, this result could possibly be more related to the smoke inhalation than to the effects of THC or other cannabinoids.

SEARCHING FOR THERAPEUTIC ALTERNATIVES

Patients with advanced chronic kidney disease experience various symptoms, such as nausea, anorexia, chronic pain, insomnia. The adverse effects of often prescribed opioids are particularly strong in chronic kidney disease patients since they can increase the severity of those symptoms. The limited treatment options actually increase the demand for therapeutic alternatives, but many patients choose not to wait for the development of an approved cannabis therapy and start experimenting with medical cannabis for symptom management [1] . Nevertheless, even if medical cannabis has been used in many therapeutic applications, the evidence of its efficacy with chronic kidney disease has not been well reviewed, and not enough literature has been accumulated in order to advise properly on assumption forms and dosage.

REDUCING SYMPTOMS WITH CBD

Even if little research is available to-date, not only patients but also the scientific community started to seriously consider cannabinoids [2] as agents against symptoms of chronic kidney disease. The combination of therapeutic value and virtually no side effects put CBD under the nephrology research lens, particularly after CBD has been reported helpful in improving the symptoms of severe kidney condition in many self-medicating patients.

A study found that CBD reduces the toxic burden on kidneys [3] caused by chemotherapy. Nephrotoxicity is a common adverse effect of the potent chemotherapy agent cisplatin, thus the oxidative and nitrosative stress limits its clinical use. Treatment of mice with cannabidiol attenuated the cellular stress, the inflammation, and cell death in the kidney caused by cisplatin, greatly improving the renal function. The results of this study suggest that CBD may act against cisplatin-induced nephrotoxicity. And of course that CBD deserves more research in this area.

EXPERIMENTING WITH CAUTION

Cannabis has very few side effects on our organs and there is no risk of a cannabinoid overdose damaging our kidneys, yet patients with kidney diseases should be particularly careful in starting alternative therapeutic regimes, and they should discuss all the supplements they take with an informed healthcare specialist. Improvements in kidney disease symptoms with the assumption of CBD and/or THC might be real and should be clinically considered, as long as these or other supplements don’t interact with prescribed drugs, and remembering that vaporization or edibles eliminate the harms related to smoking.

Researchers explore the role of the endocannabinoid system in kidney functioning and findings confirm positive results of cannabis in pain management.

CBD for Kidney Disease – November 2020

Can CBD help with kidney disease, and if so, how?

Kidney failure, also called renal failure or end-stage renal disease, is the last stage of chronic kidney disease.

When the kidneys fail, it means they have stopped working well enough for the person to survive without dialysis or a kidney transplant (1 ) .

However, even these remedies are not without adverse side effects. For instance, researchers found an increased incidence of kidney stones in patients after a kidney transplant.

Calcium based stones, such as calcium oxalate and calcium phosphate, were the most common types of kidney stones found after kidney transplantation (2 ) .

Meanwhile, studies have examined the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for chronic kidney disease (CKD) (3 ) .

Findings suggested that short-term NSAID use has adverse side effects on blood pressure elevation (4 ) .

High blood pressure is the second principal cause of kidney failure in the United States after diabetes (5 ) .

CBD for Kidney Disease: What the Research Says

There are no studies specific to the use of CBD alone and its impact on kidney health. There are, however, limited studies that examined the effects of cannabis on kidneys, and they produced mixed results.

During the American Society of Nephrology’s Kidney Week conference in October 2018, researchers shared their findings from a recent study on medical marijuana use and its side effects on kidneys (6 ) .

Marijuana and hemp belong to the s ame plant species, Cannabis sativa, but are widely different. Marijuana contains much more tetrahydrocannabinol (THC) than hemp, while hemp contains more cannabidiol (CBD).

The researchers, who studied kidney disease progression in cannabis users, found that chronic kidney disease (CKD) patients’ kidney function d eclined faster in those who used cannabis, compared to those who did not (7 ) . They did not report whether this was marijuana or hemp-derived cannabis which would have lower THC than CBD.

Joshua L. Rein, DO, who led the study, warned that kidney patients using cannabis should be aware of potential symptoms, such as nausea, lack of appetite, and chronic pain , which are all valid issues for medical marijuana usa ge (8 ) .

Meanwhile, researchers of a study published in the Journal of Pain and Symptom Management believe that even minor improvements in patients with difficult-to-treat CKD symptoms may be clinically meaningful (9 ) .

In their research, they found that cannabinoids, like CBD and THC, may present a reasonable alternative to pain and symptom management.

Another study , which was published in the Journal of Pharmacology and Experimental Therapeutics , showed that CBD might help reduce nephrotoxicity by decreasing oxidative stress, inflammation, and cell death (10 ) .

Nephrotoxicity occurs when the body is exposed to a drug or toxin that causes kidney damage, which makes the body unable to eliminate excess urine and wastes.

Still, due to limited treatment options f or chronic kidney disease (CKD), sy mptom management can be challenging.

Thus, therapeutic alternatives are in high demand, which may explain why, in recent years, medical marijuana has emerged as an attractive therapeutic option (11 ) .

As a result, medical cannabis continues to be used for a variety of indications with minimal guidance on known risks, particularly on the altered physiological state of patients w ith chronic kidney disease (CKD) (12 ) .

How CBD Works: The Endocannabinoid System Explained

According to a study published in the American Journal of Physiology – Renal Physiology in 2017, the endocannabinoid system (ECS) plays a crucial role in renal homeostasis.

While data suggest cannabis and cannabinoids could have essential effects on kidney function, there is not sufficient evidence from clinical research studies to determine the dangers faced by users of these products with respect to the development of acute kidney injury (AKI) or CKD (13 ) .

A 2016 review looked into the emerging role of the endocannabinoid system, particularly the cannabinoids and the cannabinoid receptors, in normal kidney function and other diseases, such as diabetes and obesity, that directly contribute to the development of renal diseases (14 ) .

The authors of the said review found that the activation of the CB1 receptor regulates renal vascular blood flow. Meanwhile, the renal CB2 receptor reduces the effects of inflammation, oxidative stress, and renal fibrosis.

Conclusion

The limited treatment options among individuals with CKD increase the demand for therapeutic alternatives.

Despite the current lack of approved CBD or cannabis therapy, some patients may still want to start experimenting with medical cannabis for symptom management.

However, although CBD has been used in many therapeutic applications, the evidence of its efficacy with chronic kidney disease has not been well-reviewed. Also, there is not enough literature accumulated to advise appropriately on consumption forms and dosage.

Before using CBD to treat CKD symptoms or as supplementary therapy, a consultation with a nephrologist experienced in cannabis use is strictly advised.

  1. American Kidney Fund. Kidney Failure (ESRD) Causes, Symptoms, & Treatments. Retrieved from https://www.kidneyfund.org/kidney-disease/kidney-failure/ .
  2. Cheungpasitporn W, Thongprayoon C, Mao MA, et al. Incidence of kidney stones in kidney transplant recipients: A systematic review and meta-analysis. World J Transplant. 2016;6(4):790–797. doi:10.5500/wjt.v6.i4.790.
  3. Chih-Cheng Hsu et al. Use of Nonsteroidal Anti-Inflammatory Drugs and Risk of Chronic Kidney Disease in Subjects With Hypertension. Originally published 13 Jul 2015. https://doi.org/10.1161/HYPERTENSIONAHA.114.05105 .
  4. Clive DM, Stoff JS.Renal syndromes associated with nonsteroidal antiinflammatory drugs.N Engl J Med. 1984; 310:563–572. doi: 10.1056/NEJM198403013100905.
  5. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2019.
  6. American Kidney Fund. (2018, Nov. 8). A caution about self-medication for kidney patients. Retrieved from https://www.kidneyfund.org/kidney-today/a-caution-about-self-medication-for-kidney-patients.html .
  7. Ibid.
  8. Ibid.
  9. Davison, Sara N. et al. Is There a Legitimate Role for the Therapeutic Use of Cannabinoids for Symptom Management in Chronic Kidney Disease? Journal of Pain and Symptom Management, Volume 41, Issue 4, 768 – 778.
  10. Pan H, Mukhopadhyay P, Rajesh M, et al. Cannabidiol attenuates cisplatin-induced nephrotoxicity by decreasing oxidative/nitrosative stress, inflammation, and cell death. J Pharmacol Exp Ther. 2009;328(3):708–714. doi:10.1124/jpet.108.147181.
  11. Ho C, Martinusen D, Lo C. A Review of Cannabis in Chronic Kidney Disease Symptom Management. Can J Kidney Health Dis. 2019;6:2054358119828391. Published 2019 Feb 22. doi:10.1177/2054358119828391.
  12. Ibid.
  13. Park F, Potukuchi PK, Moradi H, Kovesdy CP. Cannabinoids and the kidney: effects in health and disease. Am J Physiol Renal Physiol. 2017;313(5):F1124–F1132. doi:10.1152/ajprenal.00290.2017.
  14. Tam J. The emerging role of the endocannabinoid system in the pathogenesis and treatment of kidney diseases. J Basic Clin Physiol Pharmacol. 2016;27(3):267–276. doi:10.1515/jbcpp-2015-0055.

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Kidney failure, also called renal failure or end-stage renal disease, is the last stage of chronic kidney disease. When the kidneys fail, it means they have stopped working well enough for the person to survive without dialysis or kidney transplant. Can CBD help with kidney disease, and if so, how? ]]>