Among 441 adolescents and young adults with chronic kidney disease, cigarette smoking was associated with higher proteinuria, but marijuana, alcohol, and e-cigarette use were not associated with worsening kidney function or disease progression.
Pediatric nephrologists, adolescents with kidney disease, and clinicians counseling CKD patients about substance use.
Marijuana not associated with kidney disease progression; cigarettes were
What the researchers found
Past-year and 30-day cigarette use were significantly associated with higher proteinuria (+18.6% and +20.0% respectively). Marijuana use (reported by 15%), alcohol (39%), and e-cigarette use (17%) were not associated with proteinuria, disease progression, or elevated blood pressure in adjusted models.
Why it matters
Adolescents with chronic kidney disease face lifelong disease management. Knowing that marijuana does not appear to accelerate kidney disease (unlike cigarettes) provides important information for clinicians and families navigating substance use conversations.
The numbers in context
441 participants; 1,245 person-visits; marijuana use 15%; cigarette use associated with +18.6% higher proteinuria (P < 0.05); marijuana, alcohol, e-cigarette not associated with kidney outcomes
How the study worked
Longitudinal analysis of 441 participants aged 16+ in the CKiD study contributing 1,245 person-visits. Repeated measures regression models with contemporaneous and lagged controls assessed associations between each substance and kidney function markers.
What this study cannot tell us
Relatively low prevalence of substance use limited statistical power. Self-reported use likely underestimates actual consumption. Cannot rule out effects at higher use levels. CKiD cohort may not represent all pediatric CKD patients.
How to read the evidence
Well-established CKD cohort with longitudinal design and repeated measures, though low substance use prevalence limits power.
When this study was published
Published in 2021.
The bigger picture
While this provides some reassurance about occasional marijuana use in CKD patients, it does not mean marijuana is safe. The finding reinforces that cigarette smoking remains the most harmful common substance for kidney function.
Questions still open
- Would heavier marijuana use show kidney effects? Are there specific cannabinoids that affect kidney function? Should clinicians prioritize tobacco cessation over marijuana cessation in CKD patients?
Common questions
Does marijuana hurt kidneys?
Which substance was most harmful for kidney disease?
Read the original research
The association of alcohol, cigarette, e-cigarette, and marijuana use with disease severity in adolescents and young adults with pediatric chronic kidney disease.
Pediatric nephrology (Berlin, Germany), 36(8), 2493-2497
Citation
Molino, Andrea R; Jerry-Fluker, Judith; Atkinson, Meredith A; Furth, Susan L; Warady, Bradley A; Ng, Derek K. (2021). The association of alcohol, cigarette, e-cigarette, and marijuana use with disease severity in adolescents and young adults with pediatric chronic kidney disease.. Pediatric nephrology (Berlin, Germany), 36(8), 2493-2497. https://doi.org/10.1007/s00467-021-05044-5
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