Kidney Week

Abstract: FR-PO233

Marijuana Use and Kidney Outcomes in the ASSESS-AKI Cohort

Session Information

• CKD: Clinical, Outcomes, Trials - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Rein, Joshua L., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Joshua L. Rein,

• Texter, Lindsay, Pennsylvania State College of Medicine, Hershey, Pennsylvania, United States

Lindsay Texter,

• Wurfel, Mark M., University of Washington, Seattle, Washington, United States

Mark M. Wurfel,

• Siew, Edward D., Vanderbilt University School of Medicine, Nashville, Tennessee, United States

Edward D. Siew,

• Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada

Amit X. Garg,

• Tan, Thida C., Kaiser Permanente Northern California, Oakland, California, United States

Thida C. Tan,

• Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States

Paul L. Kimmel,

• Kaufman, James S., VA New York Harbor Healthcare System, New York, New York, United States

James S. Kaufman,

• Chinchilli, Vernon M., Pennsylvania State College of Medicine, Hershey, Pennsylvania, United States

Vernon M. Chinchilli,

• Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Steven G. Coca,

Group or Team Name

• on behalf of the Assessment Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) Study Investigators

Background

Legal recreational and medicinal use of marijuana (MJ) is increasing worldwide. Animal kidney injury models show that activation of the cannabinoid receptor CB1 can exacerbate kidney disease while activation of CB2 may be protective. Whether these effects apply to whole plant MJ remains to be determined.

Methods

We conducted a post-hoc analysis of MJ usage as a risk factor for kidney function decline and albuminuria in the ASSESS-AKI parallel matched cohort study that enrolled hospitalized adults with and without AKI from 4 US centers between 2009-2015, with a median of 4.1 years of follow-up. MJ usage was defined as responding yes to “have you used MJ since your last study visit?” at least once on any study visit questionnaire. Nonusers were defined as always responding no to this question. Kidney function decline was defined according to the parent study protocol. Association between MJ usage and the categorical and continuous outcomes were determined using multivariable Cox regression and linear mixed models, respectively.

Results

MJ users represented 113 of 1599 (7%) participants, were younger (mean age 54 vs. 65 years), mostly white (78%), men (78%), and were more likely to be heavy tobacco users (≥20 cigarettes/day; 26% vs. 8%). Baseline eGFR was higher in users vs. non-users (87 +/- 30 mL/min/1.73 m²vs. 69 +/- 26 mL/min/1.73 m²), while baseline UACR was similar (120 +/- 80 in users vs. 99 +/- 72 in nonusers). In those with baseline eGFR ≥60 mL/min/1.73 m², MJ use was not associated with incident CKD (adjusted HR 0.93; 95% CI, 0.5-1.8) or differences in eGFR slope over time (mean difference -0.12 mL/min/1.73 m²/year, P=0.7). In contrast, in those with baseline eGFR <60 mL/min/1.73 m², MJ users had more rapid eGFR decline vs. nonusers (-3.2 vs -1.4 mL/min/1.73 m²/year,P=0.002) and had a strong trend towards higher risk for CKD progression (adjusted HR 2.7; 95% CI, 0.83 to 8.5). MJ usage was not associated with the rate of change in UACR over time in those with (P=0.4) and without CKD (P=0.2).

Conclusion

MJ usage was associated with more rapid eGFR decline in those with baseline CKD, but not in those without CKD, nor was it associated with changes in albuminuria over time in those with or without CKD. Reasons for the effect modification by CKD status regarding MJ and kidney function should be explored.

Funding

• NIDDK Support