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ASN: Encephalopathy Up in CKD Patients on Higher-Dose Baclofen

Risk for hospitalization with encephalopathy higher for baclofen starting dose of ≥20 versus <20 mg/day

WEDNESDAY, Nov. 13, 2019 (HealthDay News) — The incidence of encephalopathy is increased with prescription of higher versus lower doses of baclofen among older patients with chronic kidney disease (CKD), according to a study published online Nov. 9 in the Journal of the American Medical Association. The research was published to coincide with Kidney Week, the annual meeting of the American Society of Nephrology, held from Nov. 5 to 10 in Washington, D.C.

Flory T. Muanda, M.D., Ph.D., from the Institute for Clinical Evaluative Services in London, Ontario, Canada, and colleagues compared the 30-day incidence of encephalopathy among 15,942 older adults (≥66 years) with CKD prescribed baclofen at a dose of either ≥20 mg/day or <20 mg/day (61 and 39 percent, respectively).

The researchers found that hospitalization with encephalopathy occurred in 1.11 and 0.42 percent of patients who started baclofen at ≥20 mg/day and <20 mg/day, respectively (weighted risk ratio [RR], 3.54 [95 percent confidence interval (CI), 2.24 to 5.59]; weighted risk difference [RD], 0.80 percent [95 percent CI, 0.55 to 1.04 percent]). In a subgroup analysis, there was a progressive increase in absolute risk at lower estimated glomerular filtration rate (eGFR; weighted RD: eGFR 45 to 59: 0.42 percent [95 percent CI, 0.19 to 0.64 percent]; eGFR 30 to 44: 1.23 percent [95 percent CI, 0.62 to 1.84 percent]; eGFR <30: 2.90 percent [95 percent CI, 1.30 to 4.49 percent). In a secondary comparison with 284,263 nonusers, the risk for encephalopathy was significantly higher for both groups of baclofen users (≥20 mg/day: weighted RR, 19.8 [95 percent CI, 14.0 to 28.0]; <20 mg/day: weighted RR, 5.90 [95 percent CI, 3.59 to 9.70]).

“This population-based study of 15,942 older adults confirms and extends the findings of 30 international case reports linking baclofen use with encephalopathy in patients with CKD,” the authors write.

One author disclosed financial ties to the pharmaceutical industry.

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