Nearly 1 in 10 patients with end-stage renal disease (ESRD) has epilepsy, and the disorder as well as a commonly prescribed medication for it are associated with an increased risk of premature death, a new study found.
Of 148,294 patients with ESRD in the US Renal Data System, 13,094 (8.8%) had epilepsy, Paul L. Kimmel, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases, and colleagues reported in Kidney International. That proportion was more than 7 times higher than the 1.2% found among 1.25 million general Medicare patients. Another 1.8% of ESRD patients had history of seizure.
According to the authors, seizures are a known complication of uremia, hemodialysis, medications such as antibiotics, and comorbidities such as depression, anxiety, hypertension, and cerebrovascular disease. In a fully adjusted model, patients on hemodialysis or peritoneal dialysis who had epilepsy were 11% more likely to die than those without epilepsy. An epilepsy diagnosis was associated with a 15% increase in mortality risk among patients without a neurology consultation, but a 7% increased risk among those with a consultation. Dr Kimmel and his team suggested that “involvement of neurologists in the care of ESRD patients with epilepsy may lead to more optimal care management.”
Among patients with epilepsy, 81% filled an anticonvulsant or hydantoin prescription in during 2013 to 2014 compared with 33.3% of those without epilepsy. Patients with epilepsy who were prescribed gabapentin had a significant 8% increased mortality risk compared with those prescribed another antiseizure medication (ASM).
“One interpretation of our results is that gabapentin may be the ASM most associated with mortality due to its unique pharmacokinetic properties and thus, the most difficult to use in this patient population. Specifically, gabapentin is excreted entirely by the kidney; therefore, renal dysfunction may increase the risk of toxicity,” Dr Kimmel and collaborators stated.
Waddy SP, Ward JB, Becerra AZ, et al. Epilepsy and anti-seizure medications increase all-cause mortalityin dialysis patients in the United States. Kidney Int. doi:10.1016/j.kint.2019.04.033