What drug when started at higher doses is associated with a higher 30-day risk of hospitalization with encephalopathy in older adults with CKD?
Baclofen.
A retrospective cohort study included 15,942 patients with CKD who were newly started on baclofen. The results showed that out of 9707 patients who were taking at least 20mg of baclofen per day, 108 (1.11%) patients were hospitalized with encephalopathy. Out of the 6235 patients who were taking less than 20mg of baclofen per day, 26 (0.42%) patients were hospitalized with encephalopathy. Patients who were started on at least 20mg of baclofen per day was associated with a higher 30-day risk of hospitalization with encephalopathy compared to patients who were started on less than 20mg of baclofen per day (weighted RR, 3.54 [95% CI, 2.24-5.59]; weight RD, 0.80% [95% CI, 0.55%-1.04%]). Starting dose of at least 20mg of baclofen per day was also associated with a higher risk of hospitalization with delirium as well as all-cause hospitalization. The risk of encephalopathy was higher in both groups of baclofen users compared to nonusers. Based on these results, the authors concluded that the 30-day risk of hospitalization with encephalopathy was increased among older patients who were started on higher doses compared to those who were started on lower doses and that the benefits of baclofen should be balanced against the risks.
Muanda FT, Weir MA, Bathini L, et al. Association of Baclofen With Encephalopathy in Patients With Chronic Kidney Disease. JAMA. 2019;322(20):1987–1995. doi:10.1001/jama.2019.17725
Submitted by: Jennifer Splawski, PharmD, MS, BCPS