(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, DC.

Flory T. Muanda, MD, PhD, 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%, respectively).

The researchers found that hospitalization with encephalopathy occurred in 1.11 and 0.42% of patients who started baclofen at ≥20 mg/day and <20 mg/day, respectively (weighted risk ratio [RR], 3.54 [95% confidence interval (CI), 2.24 to 5.59]; weighted risk difference [RD], 0.80% [95% CI, 0.55 to 1.04%]). 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% [95% CI, 0.19 to 0.64%]; eGFR 30 to 44: 1.23% [95% CI, 0.62 to 1.84%]; eGFR <30: 2.90% [95% CI, 1.30 to 4.49%). 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% CI, 14.0 to 28.0]; <20 mg/day: weighted RR, 5.90 [95% 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.

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One author disclosed financial ties to the pharmaceutical industry.


Muanda FT, Weir MA, Bathini L, et al. Association of Baclofen With Encephalopathy in Patients With Chronic Kidney Disease [published online November 9, 2019]. JAMA. doi:10.1001/jama.2019.17725