Baclofen neurotoxicity in uremic patients: is continuous ambulatory peritoneal dialysis less effective than intermittent hemodialysis?
OBJECTIVE
To compare the efficacy between continuous ambulatory peritoneal dialysis (CAPD) and intermittent hemodialysis in the treatment of baclofen-associated neurotoxicity.


METHODS
Three uremic patients suffering baclofen-associated neurotoxicity were treated by CAPD at our hospital. We obtain 12 cases with detailed clinical course of baclofen-associated neurotoxicity treated by hemodialysis from a literature review using the Medline and Science Citation Index, six of these patients were treated by early hemodialysis which was defined as hemodialysis intervention within 48 h of the onset of clinical toxicity.


RESULTS
Our cases regain full consciousness within 2-3 days after the onset of neurotoxicity. Clinical characteristics of our cases including age, dialysis time, preexisting central nervous system (CNS) lesion, concomitant use of CNS depressant, total baclofen dose, onset of neurotoxicity, and duration of neurotoxicity are not significantly different from reported cases that treated by either early or routine hemodialysis.


CONCLUSIONS
Baclofen should be avoided in uremic patients. When consciousness disturbance occurs in uremic patients, baclofen-associated neurotoxicity should be included in the list of differential diagnosis. According to experiences of our patients, we conclude that neither early nor routine hemodialysis is more effective than CAPD in shortening the recovery time of baclofen-associated neurotoxicity.
Division of Critical Care Nephrology, Section of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
Yung-Chang
YC
Chen
Chin-Tung
CT
Chang
Ji-Tseng
JT
Fang
Chiu-Ching
CC
Huang
D000368:Aged; D001418:Baclofen / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000209:etiology* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010531:Peritoneal Dialysis, Continuous Ambulatory; D006435:Renal Dialysis; D013997:Time Factors; D014511:Uremia / Q000150:complications* / Q000628:therapy*
D001418:Baclofen