Baclofen has a risk of encephalopathy in older adults receiving dialysis

Chauvin, Kianna; Blake, Peter G.; Garg, Amit X.; Weir, Matthew A.; Bathini, Lavanya; Dixon, Stephanie N.; McArthur, Eric; Sontrop, Jessica M.; Moist, Louise; Kim, Richard B.; Muanda, Flory T.

doi:10.1016/j.kint.2020.04.047

Cited by 13 publications

(20 citation statements)

References 22 publications

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“…30 This is particularly problematic in those with CKD; for example, baclofen confers a higher risk of encephalopathy in patients with CKD. 31 In addition, the direct effect of therapeutic muscle relaxant use, the relief of painful skeletal muscle contraction, may simultaneously raise the probability of decreasing muscular activities involving uninflamed muscles. This unwanted phenomenon can lead to postural imbalances, functional impairment, and disability if prolonged neuromuscular weakness occurs.…”

Section: Discussionmentioning

confidence: 99%

Muscle relaxant use and the associated risk of incident frailty in patients with diabetic kidney disease: a longitudinal cohort study

Lee

Wang

Tsai

et al. 2021

Therapeutic Advances in Drug Safety

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Background: Patients with diabetic kidney disease (DKD) are at an increased risk of frailty. The exposure to muscle relaxants frequently leads to adverse effects despite their modest therapeutic efficacy, but whether muscle relaxants predispose users to frailty remains unclear. Methods: Patients with DKD from a population-based cohort, the Longitudinal Cohort of Diabetes Patients, were identified between 2004 and 2011 ( N = 840,000). Muscle relaxant users were propensity score-matched to never-users in a 1:1 ratio based on demographic features, comorbidities, outcome-relevant medications, and prior major interventions. Incident frailty, the study endpoint, was measured according to a modified FRAIL scale. We used Kaplan–Meier analyses and Cox proportional hazard regression to analyze the association between cumulative muscle relaxant use (⩾ 28 days) and the risk of incident frailty. Results: Totally, 11,637 users and matched never-users were enrolled, without significant differences regarding baseline clinical features. Cox proportional hazard regression showed that patients with DKD and received muscle relaxants had a significantly higher risk of incident frailty than never-users [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.04–1.53]. This increase in frailty risk paralleled that in cumulative muscle relaxant dosages (quartile 1 versus 2 versus 3 versus 4, HR 0.91 versus 1.22 versus 1.38 versus 1.45, p = 0.0013 for trend) and in exposure durations (quartile 1 versus 2 versus 3 versus 4, HR 1.12 versus 1.33 versus 1.23 versus 1.34, p = 0.0145 for trend) of muscle relaxants. Conclusion: We found that cumulative muscle relaxant exposure might increase frailty risk. It is prudent to limit muscle relaxant prescription in patients with DKD. Plain language summary Does cumulative muscle relaxant exposure increase the risk of incident frailty among patients with diabetic kidney disease? Background: Frailty denotes a degenerative feature that adversely influences one’s survival and daily function. Patients with diabetes and chronic kidney disease are at a higher risk of developing frailty, but whether concurrent medications, especially muscle relaxants, aggravate this risk remains undefined. Methods: In this population-based study including 11,637 muscle relaxant users and matched never-users with diabetic kidney disease, we used a renowned frailty-assessing tool, FRAIL scale, to assess frailty severity and examined the incidence of frailty brought by muscle relaxant exposure. Results: We found that users exhibited a 26% higher risk of developing incident frailty compared with never-users, and the probability increased further if users were prescribed higher doses or longer durations of muscle relaxants. Conclusion: We concluded that in those with diabetic kidney disease, cumulative muscle relaxant use was associated with a higher risk of incident frailty, suggesting that moderation of muscle relaxant use in this population can be of potential importance.

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Section: Discussionmentioning

confidence: 99%

Muscle relaxant use and the associated risk of incident frailty in patients with diabetic kidney disease: a longitudinal cohort study

Lee

Wang

Tsai

et al. 2021

Therapeutic Advances in Drug Safety

View full text Add to dashboard Cite

show abstract

“…5 Although this study included patients with CKD not on dialysis, most case reports that have shown severe encephalopathy after baclofen exposure reported patients with severe acute kidney injury (AKI) or with end-stage kidney disease (ESKD) on dialysis. 6 A large population-based, retrospective cohort study published by Chauvin et al 7 in this issue of Kidney International has shed a much-needed light on the high incidence of baclofen-induced encephalopathy in patients with ESKD on dialysis. The cohort included 6469 Canadians receiving dialysis (85% hemodialysis, 20% peritoneal dialysis), of which 360 (6%) were newly prescribed baclofen "users."…”

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confidence: 99%

“…Multiple reports of baclofen neurotoxicity have already been published, and the study by Chauvin et al again demonstrates the urgent need to educate health care providers about the clear harm of baclofen in patients on dialysis. [5][6][7] Baclofen-induced encephalopathy in patients with impaired kidney function has serious implications on patient outcomes and the health care system. Educating all individuals who might prescribe baclofen is paramount.…”

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confidence: 99%

“…Although nephrologists have been actively involved in discussion of baclofen toxicity, 71% of baclofen prescriptions were written by primary care physicians rather than nephrologists. 7 Thus, we suggest that each hospital consider implementation of a warning in the electronic medical record that alerts individuals who order baclofen in patients with diminished kidney function. This type of simple intervention may help reduce the high incidence of baclofen-associated encephalopathy.…”

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confidence: 99%

“…Based on recent publications examining baclofen-induced encephalopathy in patients with impaired kidney function and previously published case reports, we recommend avoidance of baclofen use in patients on dialysis. 5,7 A diverse and far-reaching educational campaign is needed to inform health care providers who may prescribe baclofen of these risks to ensure safe medication administration whenever possible and to minimize unnecessary harm (Table 1). Excessive salt intake and vasopressin may promote cyst growth in autosomal dominant polycystic kidney disease and glomerular filtration rate (GFR) decline in chronic kidney disease.…”

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confidence: 99%

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