Marijuana Use by CKD Patients May Hasten Renal Function Decline

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Marijuana users with chronic kidney disease experienced a significantly greater annual decline in estimated glomerular filtration rate than non-users, study finds.
Marijuana users with chronic kidney disease experienced a significantly greater annual decline in estimated glomerular filtration rate than non-users, study finds.
The following article is part of conference coverage from Kidney Week 2018 in San Diego hosted by the American Society of Nephrology. Renal & Urology News staff will be reporting live on medical studies conducted by nephrologists and other specialists who are tops in their field in acute kidney injury, chronic kidney disease, dialysis, transplantation, and more. Check back for the latest news from Kidney Week 2018.

SAN DIEGO—Patients with chronic kidney disease (CKD) who use marijuana use may experience a more rapid decline in renal function than non-users, according to study findings presented at the American Society of Nephrology's Kidney Week 2018 meeting. Marijuana use was not associated with renal function decline among individuals without CKD.

The findings are from a post-hoc analysis of data from the ASSESS-AKI (Assessment Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury) matched cohort study. Investigators defined CKD as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2. Of the 1599 participants in the study, 113 (7%) used marijuana. Marijuana users were significantly younger than non-users (mean 54 vs 65 years).

Among patients with CKD at baseline, the mean annual rate of decline in eGFR was 3.22 mL/min/1.73 m2 among marijuana users compared with 1.42 mL/min/1.73 m2 among non-users, a significant difference between the groups, a team led by Joshua L. Rein, DO, of the Icahn School of Medicine at Mount Sinai in New York, reported.

Among individuals without CKD at baseline, the mean annual rate of decline in eGFR was 1.74 and 1.63 mL/min/1.73 m2 for marijuana users and non-users, respectively, a non-significant difference. In this group, marijuana use was not associated with development of CKD.

Marijuana use was not associated with changes in albuminuria over time in patients with or without CKD.
The investigators observed a strong but non-significant trend toward CKD progression—defined as a greater than 50% decrease in eGFR from baseline—among marijuana users with CKD at baseline.

“Marijuana is the most commonly used recreational drug and legal recreational and medicinal use is increasing worldwide,” Dr Rein told Renal & Urology News. “With increasing use and availability of marijuana, we felt it was important to understand the impact of marijuana use on the risk of CKD.”

Patients with advanced CKD and end-stage renal disease experience substantial symptom burden that is frequently undertreated due to adverse medication side effects, he stated. “Medical marijuana may be effective at treating chronic pain and nausea, among other symptoms common to this patient population,” Dr Rein said. “However, the effects of smoked marijuana in those with significant kidney disease are unknown.”

Marijuana use is increasing among adults, most rapidly among middle aged and elderly individuals, populations with a substantial CKD burden. “Recreationally, marijuana is most often smoked, and just like for tobacco, patients with CKD should not smoke marijuana,” Dr Rein said. “Medical marijuana is more commonly vaporized or consumed as a capsule or in food, which remove the cardiopulmonary side effects, but the renal effects remain unknown. Renal function in marijuana users with CKD should be closely monitored.”

With growing acceptance of both medical and recreational marijuana use, future research is needed to investigate the renal endocannabinoid system and the impact of marijuana use on kidney disease outcomes, he said.

Dr Rein acknowledged that his team was unable to assess the motivations or reasons for marijuana use and whether participants were using marijuana recreationally or medically.

Visit Renal & Urology News' conference section for continuous coverage from Kidney Week 2018.

Reference

Rein JL, Texter LJ, Wurfel MM, et al. Marijuana use and kidney outcomes in the ASSESS-AKI Cohort. Data presented at the American Society of Nephrology's 2018 Kidney Week conference in San Diego, Oct. 23-28. Abstract FR-PO233

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