Prevalence and risk factors of baclofen neurotoxicity in patients with severely impaired renal function
Prevalence and risk factors of baclofen neurotoxicity in patients with severely impaired renal function
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DOI：
10.1016/j.nefro.2020.03.004
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发表时间：
2020-09-01
期刊：
影响因子：
2.6
通讯作者：
Kim, Soon Bae
中科院分区：
文献类型：
--
作者：
Cheong, Minseon;Lee, Jongmin;Kim, Soon Bae
背景/目的：用于治疗打嗝和痉挛的巴氯芬最常见的不良反应是神经毒性。由于巴氯芬主要由肾脏排泄，因此慢性肾病（CKD）患者更可能发生神经毒性。我们评估了巴氯芬神经毒性的危险因素和重度CKD患者的推荐剂量。方法：在这项单中心回顾性研究中，我们将401例CKD患者分为4期（n = 174），非透析5期（n = 97）和透析中（n = 130）。重度CKD患者中巴氯芬诱导的神经毒性的发生率为7.0%（401例患者中的28例）。当患者被分类为CKD 4期、5期和透析患者时，神经毒性的存在没有显著差异。有神经毒性的患者与无神经毒性的患者之间血清白蛋白水平和糖尿病肾病的存在有显著差异。多元logistic回归分析结果显示，血清白蛋白与巴氯芬神经毒性独立相关（p = 0.007）。巴氯芬神经毒性的最小日剂量分别为10 mg，10 mg和5 mg，在CKD 4期和5期患者，和dialysis，respectively.Conclusions：在这项研究中，细菌诱导的神经毒性的患病率在重度CKD患者为7.0%。血清白蛋白被确定为神经毒性的独立风险因素。我们建议4期和5期重度CKD患者初始日剂量为7.5 mg，接受透析的患者日剂量为2.5 mg。(C)2020年西班牙语Nefrologia协会。出版社：Elsevier Espana，S.L.U.
Background/aims: The most common adverse effect of baclofen, used for managing hiccups and spasticity, is neurotoxicity. As baclofen is primarily excreted by the kidneys, neurotoxicity is more likely to occur in patients with chronic kidney disease (CKD). We evaluated the risk factor for baclofen neurotoxicity and the recommended dosage for patients with severe CKD.Methods: In this single-center retrospective study, we classified 401 patients with CKD as stage 4 (n = 174), non-dialysis stage 5 (n = 97), and on-dialysis (n = 130).Results: The prevalence of baclofen-induced neurotoxicity in patients with severe CKD was 7.0% (28 of 401 patients). There was no significant difference in the presence of neurotoxicity when the patients were classified as CKD stage 4, stage 5, and dialysis patients. There were significant differences in serum albumin levels and the presence of diabetic nephropathy between the patients with neurotoxicity and those without. The results from a multiple logistic regression analysis showed that serum albumin was independently associated with baclofen neurotoxicity (p = 0.007). The minimum daily dose for baclofen neurotoxicity was 10 mg, 10 mg, and 5 mg in patients with CKD stages 4 and 5, and dialysis, respectively.Conclusions: In this study, the prevalence of baclofen-induced neurotoxicity in patients with severe CKD was 7.0%. Serum albumin was identified as an independent risk factor for neurotoxicity. We recommend initially administering a daily dose of 7.5 mg for patients with severe CKD stages 4 and 5, and a daily dose of 2.5 mg for patients receiving dialysis. (C) 2020 Sociedad Espanola de Nefrologia. Published by Elsevier Espana, S.L.U.