Baclofen Neurotoxicity in Uremic Patients: Is Continuous Ambulatory Peritoneal Dialysis Less Effective Than Intermittent Hemodialysis?

Figures & data

Table 1. Summary of uremic patients with Baclofen-associated neurotoxicity treated by CAPD

	Case 1	Case 2	Case 3
Age (y)	50	58	76
Sex	Male	Male	Male
Underlying disease of uremia	Diabetic nephropathy	Chronic glomerulonephritis	Hypertension
Dialysis modalitya	CAPD	CAPD	CAPD
Dialysis timeb (y)	1.5	3.0	0.25
CNS lesionc	Nil	Nil	Nil
CNS depressantd	(+)	Nil	(+)
Daily baclofen dose	5 mg qid	5 mg tid	10 mg tid
Total baclofen dose (mg)	85	25	20
Onset of neurotoxicitye (d)	4.5	1.5	1.5
Manifestations of neurotoxicity	Consciousness disturbance agitation	Consciousness disturbance	Consciousness disturbance
Duration of neurotoxicity (d)	2.0	3.0	2.0
Treatment modalityf	CAPD	CAPD	CAPD

CAPD: continuous ambulatory peritoneal dialysis; CNS: central nervous system; y: year; d: day.

^aMaintenance dialysis mode for ESRD.

^bDuration of maintenance dialysis.

^cPreexisting CNS lesion.

^dConcomitant CNS depressant.

^eTime from the initiation of baclofen to the onset of clinical intoxication.

^fDialysis mode during neurotoxicity.

Table 2. Comparison of the clinical variables between the CAPD and the hemodialysis groups

Patient	Age (y)	Dialysis modalitya	Treatment dialysis modeb	Dialysis time (y)c	CNS lesiond	CNS depressante	Total baclofen dose (mg)	Onsetf (d)	Neurotoxicityg (d)
Current report (n = 3)
1	50	CAPD	CAPD	1.5	−	+	85	4.5	2
2	58	CAPD	CAPD	3	−	−	25	1.5	3
3	76	CAPD	CAPD	0.25	−	+	20	1.5	2
Literature review (n = 12)
4^2	65	HD	Early HD	2	−	−	40	1	3
5^2	55	HD	Early HD	3	−	−	45	3	3
6^2	39	HD	Early HD	1	+	−	35	2.5	2
7^2	39	HD	Early HD	1.5	−	+	15	0.8	2
8^2	66	HD	Early HD	4	−	−	20	3.3	1
9^2	47	HD	Early HD	16	−	+	20	0.8	4
10^4	57	HD	HD	?	+	−	40	1	4
11^5	29	HD	HD	?	−	−	70	5	1
12^5	48	HD	HD	?	−	−	40	4	1
13^6	64	HD	HD	0.6	−	−	12.5	3	5
14^7	69	HD	HD	1.6	+	−	20	1.5	2
15^8	65	HD	HD	0.5	+	−	20	4	0.25
p*	0.386				0.516	0.154	0.555	0.771	0.882

p*: Comparison between the CAPD group and the hemodialysis (early and routine) group.

CAPD: continuous ambulatory peritoneal dialysis; CNS: central nervous system; HD: hemodialysis; Early HD: hemodialysis intervention within 48 h of the onset of clinical toxicity; d: day; y: year.

^aMaintenance dialysis mode for ESRD.

^bDialysis mode during neurotoxicity.

^cDuration of maintenance dialysis.

^dPreexisting CNS lesion.

^eConcomitant CNS depressant.

^fTime from the initiation of baclofen to the onset of clinical intoxication.

^gDuration of neurotoxicity.

Table 3. Comparison of the clinical variables between the CAPD and the early hemodialysis groups

Variablesa	CAPD (n = 3)	Early HD (n = 6)	p
Age (y)	58 (50, 76)	51 (39, 66)	0.300
Dialysis timeb (y)	1.5 (0.25, 3.0)	2.5 (1, 16)	0.298
% of CNS lesionc	0	16.7	1.000
% of CNS depressantd	66.7	33.3	0.524
Total baclofen dose (mg)	25 (20, 85)	27.5 (15, 45)	0.599
Onsete(d)	1.5 (1.5, 4.5)	1.7 (0.8, 3.3)	0.435
Neurotoxicityf (d)	2 (2, 3)	2.5 (1, 4)	0.784

CAPD: continuous ambulatory peritoneal dialysis; CNS: central nervous system; Early HD: hemodialysis intervention within 48 h of the onset of clinical toxicity; y: year; d: day.

^aData was presented as median (minimum, maximum) except for percentage of CNS lesion and CNS depressant.

^bDuration of maintenance dialysis.

^cPreexisting CNS lesion.

^dConcomitant CNS depressant.

^eTime from the initiation of baclofen to the onset of clinical intoxication.

^fDuration of neurotoxicity.