Cannabis-Containing Cream for CKD-Associated Pruritus: A Double-Blind, Placebo Controlled Trial

Abstract

Rationale & ObjectiveThis study aims to compare the efficacy of a cannabis cream and a placebo in the treatment of chronic kidney disease (CKD)-associated pruritus. Study DesignA double-blind randomized controlled study. Setting & ParticipantsSixty hemodialysis patients with the Worst Itching Intensity Numerical Rating Scale (WI-NRS) ≥ 3. ExposurePatients received cannabis cream or placebo. OutcomesThe primary endpoint was the WI-NRS score at week 4. The secondary endpoints included the WI-NRS at week 2, Skindex-10 score at week 2 and 4, and the mean difference score between baseline and week 4 for WI-NRS and the Skindex-10 score Analytical ApproachWe utilized unpaired t-tests or Mann–Whitney U tests, along with Chi-square or Fisher’s exact tests as appropriate. Adjusted mean differences were determined using ANCOVA, adjusting for baseline scores. ResultsAmong 60 participants, mean age was 61.6 ± 14.4 years and mean baseline WI-NRS was 6.7 ± 1.7. The placebo and cannabis cream groups were similar at baseline, although more individuals in the placebo group had diabetes. At 4 weeks, the WI-NRS dropped to 2.6 in the cannabis group and 3.6 in the placebo group (mean difference after adjustment for baseline scores:-1.1, 95% CI: -2.1 to -0.2, p = 0.02). Skindex-10 scores at week 4 were also lower in the cannabis group, but after adjustment for baseline scores, statistical significance was not maintained. No side effects were observed in either group. LimitationsA single study with a small sample size restricts its generalizability. Variances in participants' diabetes statuses might have impacted itch outcomes. The absence of cannabinoid level assessment in blood prevents conclusive determination of potential systemic impacts. A four-week follow-up period inadequately captures long-term effect. ConclusionsIn CKD-associated pruritus, the topical cream containing cannabis significantly reduced the severity of itching symptoms compared to the placebo.