The nephrologistʼs guide to cannabis and cannabinoids

Rein, Joshua L.

doi:10.1097/mnh.0000000000000590

Cited by 41 publications

(17 citation statements)

References 207 publications

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“…Nodular glomerulosclerosis has been reported in native kidneys from chronic marijuana use without diabetes or other intrinsic kidney diseases 40 . Other extra renal concerns with its use include the potential for other substances abuse 41 and the risk for pulmonary aspergillosis associated with smoking cannabis 42‐44 …”

Section: Discussionmentioning

confidence: 99%

“…40 Other extra renal concerns with its use include the potential for other substances abuse 41 and the risk for pulmonary aspergillosis associated with smoking cannabis. [42][43][44] Activation of cannabinoid receptors on donor-derived T cells demonstrated amelioration of GVHD in murine model. 45 Cannabidiol (CBD) has shown to decrease incidence and severity of graft-versushost-disease in allogenic hematopoietic cell transplantation, in a Phase two study.…”

Section: Ta B L Ementioning

confidence: 99%

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Epidemiology of cannabis use and associated outcomes among kidney transplant recipients: A meta‐analysis

Vaitla

Hansrivijit

Kanduri

et al. 2020

J Evidence Based Medicine

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Objective: Cannabis is the most commonly used recreational drug in the United States, and transplant acceptability for cannabis using candidates varies among transplant centers. However, the prevalence and impact of cannabis use on outcomes of kidney transplant recipients remain unclear. This study aimed to summarize the prevalence and impact of cannabis use on outcomes after kidney transplantation.Methods: A literature search was performed using Ovid MEDLINE, EMBASE, and The Cochrane Library Databases from inception until September 2019 to identify studies assessing the prevalence of cannabis use among kidney transplant recipients, and reported adverse outcomes after kidney transplantation. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird.Results: A total of four cohort studies with a total of 55 897 kidney transplant recipients were enrolled. Overall, the pooled estimated prevalence of cannabis use was 3.2% (95% CI 0.4%-20.5%). While the use of cannabis was not significantly associated with all-cause allograft failure (OR = 1.31, 95% CI 0.70-2.46) or mortality (OR = 1.52, 95% CI 0.59-3.92), the use of cannabis among kidney transplant recipients was significantly associated with increased death-censored graft failure with pooled OR of 1.72 (95% CI 1.13-2.60). Conclusions:The overall estimated prevalence of cannabis use among kidney transplant recipients is 3.2%. The use of cannabis is associated with increased deathcensored graft failure, but not mortality after kidney transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Ta B L Ementioning

confidence: 99%

Epidemiology of cannabis use and associated outcomes among kidney transplant recipients: A meta‐analysis

Vaitla

Hansrivijit

Kanduri

et al. 2020

J Evidence Based Medicine

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“…Cannabinoids are thought to be safe in patients with chronic kidney disease (CKD), including end stage renal disease; monitoring of renal function may be helpful [51,52]. Clinicians should recommend using the lowest effective dose, and abstaining from illicit Fig.…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

“…Key considerations when initiating and titrating medical cannabis. cannabis sources, as they may be contaminated with heavy metals, pesticides, and solvents, which may increase toxicity in people with CKD [51,52]. Smoked cannabis should be avoided in case of cardiorenal effects [51].…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

“Is medical cannabis safe for my patients?” A practical review of cannabis safety considerations

MacCallum

Boivin

2021

European Journal of Internal Medicine

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Medical cannabis use is increasing worldwide. Clinicians are commonly asked by patients to provide guidance on its safety and efficacy. Although there has been an increase in research on the role of medical cannabis for a number of different conditions, we found that there was a paucity of clear safety guidance on its use. We aim to address this issue by answering two pertinent clinician safety questions:1 Can medical cannabis be safely used in this patient? 2. What strategies can be used to ensure that any harms from medical cannabis are mitigated?To address these questions, we reviewed available evidence and provided expert clinical opinion to summarize the fundamental components for evaluating medical cannabis safety and strategies to reduce risk from its use. Our review resulted in a safety-focused framework for medical cannabis initiation and utilization. We provide clear recommendations for patients being considered for cannabis (e.g. precautions, contraindications and drug interactions). Risk mitigation strategies such as appropriate chemovar (strain) selection, routes of administration, and dosing are reviewed. As with any other pharmacotherapy, we review the key components of monitoring and address potential issues that may arise while using medical cannabis. We propose a structured assessment and monitoring strategy that can be used by clinicians recommending cannabis (CRC) to guide patients through each step of their cannabis journey. This framework can be used to ensure that medical cannabis utilization is associated with the lowest possible risk to the patient.

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“…In one double-blind study of 11 healthy adults, in which CBD or a placebo at doses of 300 mg or 600 mg were administered by injection, basal prolactin and growth hormone levels remained unchanged both after placebo and CBD. We have yet to identify literature which suggests CBD has any adverse effect on kidney function ( Rein, 2020 ). As a result, the goal of the current study was to assess the biochemical safety of CBD-rich cannabis oil in children with ASD.…”

Section: Introductionmentioning

confidence: 99%

Medical cannabis for the treatment of comorbid symptoms in children with autism spectrum disorder: An interim analysis of biochemical safety

et al. 2022

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Background: Autistic Spectrum Disorder (ASD) is a common neurodevelopmental disorder and no effective treatment for the core symptoms is currently available. The present study is part of a larger clinical trial assessing the effects of cannabis oil on autism co-morbidities.Objectives: The aim of the present study was to assess the safety of a CBD-rich oil treatment in children and adolescents with ASD.Methods: Data from 59 children and young adults (ages 5–25 years) from a single-arm, ongoing, prospective, open-label, one center, phase III study was analyzed. Participants received the Nitzan Spectrum® Oil, with cannabis extracts infused in medium chain triglyceride (MCT) oil with a cannabidiol:THC ratio of 20:1, for 6 months. Blood analysis was performed before treatment initiation, and after 3 months. Complete blood count, glucose, urea, creatinine, electrolytes, liver enzymes (AST, ALT, gamma glutamyl transferase), bilirubin, lipid profile, TSH, FT4, thyroid antibodies, prolactin, and testosterone measurements were performed at baseline, prior to starting treatment and at study midpoint, after 3 months of treatment.Results: 59 children (85% male and 15% female) were followed for 18 ± 8 weeks (mean ±SD). The mean total daily dose was 7.88 ± 4.24 mg/kg body weight. No clinically significant differences were found in any of the analytes between baseline and 3 months follow up. Lactate dehydrogenase was significantly higher before treatment (505.36 ± 95.1 IU/l) as compared to its level after 3 months of treatment (470.55 ± 84.22 IU/L) (p = 0.003). FT4 was significantly higher after 3 months of treatment (15.54 ± 1.9) as compared to its level before treatment (15.07 ± 1.88) (p = 0.03), as was TSH [(2.34 ± 1.17) and (2.05 ± 1.02)] before and after 3 months of treatment, respectively (p = 0.01). However, all these values were within normal range. A comparison of the group with additional medications (n = 14) to those who received solely medical cannabis (n = 45) showed no difference in biochemical analysis, including liver enzymes, which remained stable, except for change in potassium level which was significantly higher in the group that did not receive additional medications (0.04 ± 0.37) compared to the group receiving concomitant drug therapy (-0.2 ± 0.33) (p = 0.04). A comparison of patients who received a high dose of the cannabis oil (upper quartile-16 patients), with those receiving a low dose (lower quartile—14 patients) showed no significant difference between the two groups, except for the mean change of total protein, which was significantly higher among patients receiving high dose of CBD (0.19 ± 2.74) compared to those receiving a low dose of CBD (1.71 ± 2.46 (p = 0.01), and mean change in number of platelets, that was significantly lower among patients who received high dose of CBD (13.46 ± 31.38) as compared to those who received low dose of CBD (29.64 ± 26.2) (p = 0.0007). However, both of these changes lack clinical significance.Conclusion: CBD-rich cannabis oil (CBD: THC 20:1), appears to have a good safety profile. Long-term monitoring with a larger number of participants is warranted.

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The nephrologistʼs guide to cannabis and cannabinoids

Cited by 41 publications

References 207 publications

Epidemiology of cannabis use and associated outcomes among kidney transplant recipients: A meta‐analysis

Epidemiology of cannabis use and associated outcomes among kidney transplant recipients: A meta‐analysis

“Is medical cannabis safe for my patients?” A practical review of cannabis safety considerations

Medical cannabis for the treatment of comorbid symptoms in children with autism spectrum disorder: An interim analysis of biochemical safety

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