A patient with kidney disease was started on dialysis for vomiting that was actually caused by cannabinoid hyperemesis syndrome | Research

The takeaway

A 37-year-old man with renal insufficiency and daily marijuana use had dialysis initiated for presumed uremic vomiting, but dialysis did not improve symptoms and marijuana cessation resolved them completely, revealing cannabinoid hyperemesis syndrome as the true cause.

Nephrologists evaluating dialysis initiation; emergency physicians; internal medicine practitioners managing patients with kidney disease and cannabis use.

Unnecessary dialysis initiated for CHS misdiagnosed as uremia

What the researchers found

A 37-year-old man with bipolar disorder (treated with lithium) had progressive renal insufficiency from interstitial fibrosis. When he developed persistent severe nausea and vomiting, it was attributed to uremia (toxin buildup from kidney failure).

Dialysis was initiated but did not improve his symptoms. Multiple investigations found no other cause.

The patient had a history of daily marijuana use that predated the nausea and vomiting. When he stopped using marijuana, his symptoms resolved completely.

He elected to discontinue dialysis and was still alive 7 months later, confirming that the nausea was not uremia-driven.

The case illustrates how CHS can masquerade as uremic symptoms in patients with coexisting kidney disease, potentially leading to unnecessary dialysis.

Why it matters

Dialysis is a major medical intervention with significant impact on quality of life. This case shows that CHS can mimic uremic symptoms convincingly enough to trigger dialysis initiation. In patients with kidney disease who also use cannabis, CHS should be considered before attributing vomiting to uremia.

The numbers in context

Patient was 37 years old. Daily marijuana use. Dialysis initiated but ineffective. Symptoms resolved with marijuana cessation. Patient alive and off dialysis 7 months later.

How the study worked

Single case report with clinical follow-up. Diagnosis of CHS confirmed by symptom resolution with marijuana cessation and lack of improvement with dialysis.

What this study cannot tell us

Single case report. The patient did have real kidney disease, so some component of his symptoms could have been uremic. The definitive test (symptom resolution with cessation) is retrospective.

How to read the evidence

Preliminary. Single case report, but the clinical lesson about misdiagnosis leading to unnecessary dialysis is important.

When this study was published

Published in 2018. CHS awareness has increased, particularly in patients with comorbidities that can mask the diagnosis.

The bigger picture

As cannabis use rises across all patient populations, the potential for CHS to mimic other conditions grows. This case is particularly striking because it led to an invasive, life-altering intervention (dialysis) that turned out to be unnecessary.

Questions still open

How many patients with kidney disease and concurrent cannabis use have been started on dialysis for CHS symptoms? Should cannabis use screening be standard before dialysis initiation for nausea/vomiting?

Common questions

What is uremia?

Uremia occurs when the kidneys fail to filter waste products from the blood. Toxin buildup causes symptoms including nausea, vomiting, fatigue, and confusion. Dialysis is a standard treatment that filters the blood mechanically.

How did they know it was CHS and not uremia?

Two key clues: dialysis (which effectively treats uremic symptoms) did not improve the vomiting, and marijuana cessation completely resolved it. The patient was able to stop dialysis and remained well 7 months later.

Read the original research

Cannabinoid Hyperemesis Syndrome Masquerading as Uremia: An Educational Case Report.

Canadian journal of kidney health and disease, 5, 2054358118791146

View on PubMed ↗Publisher’s paper ↗

Citation

Klassen, Judith; Wilson, Gail. (2018). Cannabinoid Hyperemesis Syndrome Masquerading as Uremia: An Educational Case Report.. Canadian journal of kidney health and disease, 5, 2054358118791146. https://doi.org/10.1177/2054358118791146