Related Experiment Videos
Cocaine use, hypertension, and end-stage renal disease
K C Norris1, M Thornhill-Joynes, C Robinson
1Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA. knorris@ucla.edu
Insights
Cocaine use is strongly linked to hypertension-related end-stage renal disease (HTN-ESRD) in urban dialysis patients. Cocaine users developed HTN-ESRD earlier and should be considered a cause of renal failure.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Toxicology
Background:
- Cocaine use is linked to acute kidney injury and hypertension (HTN).
- Emerging data suggest cocaine may cause chronic kidney disease.
- Hypertension-related end-stage renal disease (HTN-ESRD) is a significant health concern.
Purpose of the Study:
- To investigate the association between cocaine use and HTN-ESRD in hemodialysis patients.
- To compare the prevalence of HTN-ESRD in cocaine users versus non-users.
- To identify characteristics of HTN-ESRD patients with a history of cocaine use.
Main Methods:
- Cross-sectional study design.
- Evaluation of 193 Black patients from urban hemodialysis units.
- Data collection on cocaine use history and HTN-ESRD diagnosis.
Main Results:
- 28.5% of patients reported significant cocaine use before dialysis.
- Cocaine users had a significantly higher prevalence of HTN-ESRD (89.1% vs. 46.4%).
- Cocaine users with HTN-ESRD were younger and had a shorter duration of HTN.
Conclusions:
- A history of cocaine use is strongly associated with HTN-ESRD in this urban dialysis population.
- Cocaine use is linked to an earlier onset of end-stage renal disease (ESRD).
- Cocaine should be considered a potential cause of ESRD, especially in patients lacking a clear etiology.
Abstract:
Cocaine use has been associated with both acute renal failure and hypertension (HTN), but only recently have data suggested it may lead to a chronic insidious form of renal failure. We designed a cross-sectional study to compare the association of cocaine use in hemodialysis patients with and without a diagnosis of HTN-related end-stage renal disease (HTN-ESRD). Two hundred one black patients from two outpatient hemodialysis units in an urban community were evaluated. There were 193 eligible patients, 106 men and 87 women, aged 49.28 +/- 14.4 years. A history of significant cocaine use before dialysis was reported by 55 of 193 subjects (28.5%). A diagnosis of HTN-ESRD was reported in 49 of 55 cocaine users (89.1%) compared with 64 of 138 nonusers (46.38%; odds ratio, 9.44; 95% confidence interval, 3.79 to 23.49; P < 0.0005). Of the 113 subjects with HTN-ESRD, 49 subjects (43.4%) had a history of cocaine abuse, either alone or in combination with other drugs. Subjects with HTN-ESRD with cocaine use were younger than those without cocaine use (40.7 +/- 9.0 versus 53.8 +/-15.3 years; P < 0.0005) and had a shorter reported duration of HTN (5.3 +/- 5.4 versus 12.7 +/- 9.8 years; P < 0.0005, adjusted for age and sex). In our urban dialysis population, a clinical diagnosis of HTN-ESRD was strongly associated with a history of cocaine use and earlier onset of ESRD. Cocaine should be considered as a cause of ESRD in patients without a clear cause of renal failure.