Patient Views Regarding Cannabis Use in Chronic Kidney Disease and Kidney Failure

A Survey Study

David Collister; Gwen Herrington; Lucy Delgado; Reid Whitlock; Karthik Tennankore; Navdeep Tangri; Remi Goupil; Annie-Claire Nadeau-Fredette; Sara N. Davison; Ron Wald; Michael Walsh

Disclosures

Nephrol Dial Transplant. 2022;38(4):922-931.

Abstract and Introduction

Abstract

Background: Cannabis is frequently used recreationally and medicinally, including for symptom management in patients with kidney disease.

Methods: We elicited the views of Canadian adults with kidney disease regarding their cannabis use. Participants were asked whether they would try cannabis for anxiety, depression, restless legs, itchiness, fatigue, chronic pain, decreased appetite, nausea/vomiting, sleep, cramps and other symptoms. The degree to which respondents considered cannabis for each symptom was assessed with a modified Likert scale ranging from 1 to 5 (1, definitely would not; 5, definitely would). Multilevel multivariable linear regression was used to identify respondent characteristics associated with considering cannabis for symptom control.

Results: Of 320 respondents, 290 (90.6%) were from in-person recruitment (27.3% response rate) and 30 (9.4%) responses were from online recruitment. A total of 160/320 respondents (50.2%) had previously used cannabis, including smoking [140 (87.5%)], oils [69 (43.1%)] and edibles [92 (57.5%)]. The most common reasons for previous cannabis use were recreation [84/160 (52.5%)], pain alleviation [63/160 (39.4%)] and sleep enhancement [56/160 (35.0%)]. Only 33.8% of previous cannabis users thought their physicians were aware of their cannabis use. More than 50% of respondents probably would or definitely would try cannabis for symptom control for all 10 symptoms. Characteristics independently associated with interest in trying cannabis for symptom control included symptom type (pain, sleep, restless legs), online respondent {β = 0.7 [95% confidence interval (CI) 0.1–1.4]} and previous cannabis use [β = 1.2 (95% CI 0.9–1.5)].

Conclusions: Many patients with kidney disease use cannabis and there is interest in trying cannabis for symptom control.

Graphical Abstract

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Introduction

Symptoms are common in patients with chronic kidney disease (CKD) and kidney failure^[1] but they are often unrecognized and/or undertreated.^[2] These symptoms include fatigue (71%), itchiness (55%), anorexia (49%), pain (47%), insomnia (44%), anxiety (38%), nausea (33%), restless legs syndrome (RLS) (30%) and depression (27%). Itchiness, fatigue, insomnia, depression, cramps and RLS were also 6 of the top 10 research priorities for Canadian patients with kidney failure.^[3] There are few effective treatments for many of these symptoms^[4–7] and residual symptoms often persist despite therapy, demonstrating the need for new treatments.

Cannabis is a promising therapy for many symptoms,^[8–10] as it interacts with CB1, CB2^[11] and non-cannabinoid receptors located throughout the body.^[12,13] Cannabinoids are clinically indicated to treat chronic neuropathic pain^[14] and chemotherapy-induced nausea and vomiting (CINV)^[15] and for appetite stimulation in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).^[16] There is an urgent need to evaluate the efficacy and safety of cannabis for symptom control in patients with CKD and kidney failure.

In this study we surveyed adult Canadian patients with kidney disease regarding their views and previous experiences with cannabis, interest in using it to treat individual symptoms and barriers to its uptake in clinical and research settings.

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Table 1. Characteristics of survey respondents ( n = 320)
Characteristics		n (%)	Response rate (%) (in-person recruitment)
Response type	In person	290 (90.6)
	Online	30 (9.4)
Age (years)	≤30	3 (0.9)
	>30–40	12 (3.8)
	>40–50	42 (13.2)
	>50–60	66 (20.6)
	>60–70	81 (25.6)
	>70	113 (35.6)
Gender	Male	187 (59.0)
	Female	125 (39.4)
	Other	3 (0.9)
Province	Nova Scotia	91 (28.4)	30.0
	New Brunswick	1 (0.3)	n/a
	Quebec	55 (17.2)	27.1
	Ontario	84 (26.3)	30.0
	Manitoba	69 (21.6)	33.0
	Alberta	14 (4.4)	8.5
	British Columbia	6 (1.9)	n/a
Kidney disease	CKD disease	31 (9.9)
	In-centre HD	238 (75.8)
	PD	11 (3.5)
	Home HD	17 (5.4)
	Transplant	11 (3.5)
	Other	6 (1.9)
Previous cannabis use	Yes	160 (50.2)
	No	158 (49.5)
	Prefer not to say	1 (0.3)

Missing data included age (n = 3), gender (n = 3), kidney disease (n = 6) and previous cannabis use (n = 1).
n/a: not applicable.

Table 2. Likelihood of trying cannabis for symptom control in a clinical setting
Symptom	Likert scale^a					Not applicable^b, n	Symptom prevalence (%)	No response, n	Mean (SD)	Proportion with support (95% CI)^c
Symptom	1	2	3	4	5	Not applicable^b, n	Symptom prevalence (%)	No response, n	Mean (SD)	Proportion with support (95% CI)^c
Anxiety	36	18	36	50	61	103	66.1	16	3.41 (1.45)	0.55 (0.48–0.62)
Depression	30	20	25	51	52	127	58.4	15	3.42 (1.44)	0.58 (0.50–0.65)
Restless legs	36	11	30	51	72	106	65.4	14	3.56 (1.47)	0.62 (0.54–0.68)
Itchiness	40	20	31	57	70	88	71.2	14	3.44 (1.48)	0.58 (0.51–0.65)
Fatigue	47	21	32	58	78	71	76.9	13	3.42 (1.51)	0.58 (0.51–0.64)
Pain	38	10	17	59	95	86	71.8	15	3.74 (1.48)	0.70 (0.64–0.76)
Appetite	43	22	18	42	50	127	57.9	18	3.19 (1.57)	0.53 (0.45–0.60)
Nausea/vomiting	37	12	23	47	41	142	53.0	18	3.27 (1.50)	0.55 (0.47–0.63)
Sleep	41	10	23	69	103	58	80.9	16	3.74 (1.46)	0.70 (0.64–0.76)
Cramps	41	9	31	68	53	97	67.6	21	3.41 (1.44)	0.60 (0.53–0.67)

^aLikert scale ranged from 1 to 5, with 1 being 'definitely would not', 2 being 'probably would not', 3 being 'undecided', 4 being 'probably would' and 5 being 'definitely would' be in favour of trying cannabis for symptoms in a clinical setting.
^bSymptom is not relevant to the respondent (they do not have this symptom).
^cProportion of respondents with Likert response option 4 ('probably would') or 5 ('definitely would').

Table 3. Multivariable model of likelihood of trying cannabis for symptom control
Variables		β	Lower 95% CI	Upper 95% CI	P-value
Symptom	Anxiety (reference)
	Depression	−0.1	−0.2	0.1	.32
	RLS	0.2	0.1	0.4	<.01
	Itchiness	0.1	0.0	0.3	.06
	Fatigue	0.1	−0.1	0.2	.21
	Pain	0.4	0.2	0.5	<.01
	Appetite	−0.2	−0.3	0.0	.03
	Nausea/vomiting	0.0	−0.1	0.2	.86
	Sleep	0.3	0.2	0.5	<.01
	Cramps	0.1	0.0	0.3	.08
Response	Mail (reference)
	Online	0.7	0.1	1.4	.03
Age (years)	30–40 (reference)
	<30	0.1	−1.4	1.5	.94
	>40–50	0.1	−0.6	0.8	.80
	>50–60	−0.3	−1.0	0.4	.40
	>60–70	−0.2	−0.9	0.5	.53
	>70	−0.2	−0.9	0.5	.63
Gender	Male (reference)
	Female	0.1	−0.2	0.4	.54
	Other	1.1	−0.5	2.8	.18
Province	Ontario (reference)
	Alberta	0.0	−0.7	0.7	.98
	British Columbia	0.0	−1.2	1.2	1
	Manitoba	0.6	0.2	1.0	<.01
	New Brunswick	−0.5	−2.8	1.9	.68
	Nova Scotia	0.4	0.1	0.8	.02
	Quebec	0.2	−0.2	0.7	.32
Kidney disease	HD (reference)
	CKD	−0.2	−0.7	0.3	.37
	Home HD	0.1	−0.5	0.7	.84
	Kidney transplant	−0.2	−1.2	0.8	.69
	PD	−0.6	−1.4	0.2	.16
	Other	−0.3	−1.3	0.7	.56
Previous cannabis use	No previous cannabis use (reference)
	Prefer not to say	−0.4	−2.6	1.8	.71
	Yes	1.2	0.9	1.5	<.01