Abstract
Background: The impact of recreational marijuana use/cannabis use disorder (CUD) in elderly chronic kideney disease (CKD) patients remains unknown amidst the rising use of cannabis in the USA. We conducted a nationwide study to assess the impact of CUD on cardiovascular outcomes in these patients. Methods: We used National Inpatient Sample (2016-2019) and geriatric (≥65 years) admissions with CKD. We compared baseline characteristics, comorbidities and composite in-hospital outcomes [MACCE- all-cause mortality, acute myocardial infarction-AMI, cardiac arrest and acute ischemic stroke-AIS] between the age-matched (1:1 propensity score matching) CUD+ vs. CUD- cohorts. Results: Age-matched (median 70 years, p=0.998) geriatric CKD-CUD+ (n=34255) and CUD- (n=34225) cohorts were compared. CUD+ cohort often consisted of males (75.0 vs. 53.8%), blacks (35.9 vs 20.8%) and patients from lowermost income quartile (38.7 vs. 33.5%) (p<0.001). CUD+ cohort had a higher burden of smoking, depression, PVD, and hypertension (p<0.05). Multivariate analysis did not find association between CUD and overall MACCE in CKD patients (aOR 1.05, 95CI 0.93-1.18, p=0.433). Odds of AMI was 1.24 times higher in CUD+ cohort [aOR 1.24, 95CI 1.07-1.43, p=0.005], however, no significant association was found for AIS, cardiac arrest. Inpatient mortality was significantly lower in CUD+ cohort [aOR 0.59, 95CI 0.46-0.75, p<0.001]. Males [aOR 1.20], HTN [aOR=1.31], hyperlipidemia [aOR 1.48], diabetes [aOR=1.01], alcohol abuse [aOR 1.01], PVD [aOR=1.26], cancer [aOR=1.01], South region admissions [aOR=1.31] were significant positive predictors of MACCE in the geriatric-CKD-CUD+ cohort. Smoking (OR=0.79), depression (OR=0.72) and obesity (OR=0.74) demonstrated paradox effect on MACCE with CUD. Conclusions: Recreational cannabis use in the geriatric population with comorbid CKD was not associated with increased composite MACCE, however, increased the risk of AMI.
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