Seizures have been associated with uremia, but there are few data regarding the prevalence,
treatment, and outcomes of patients with end-stage renal disease (ESRD) with epilepsy
compared to those with ESRD without epilepsy. Here we conducted a retrospective cohort
study using the United States Renal Data System to assess mortality and antiseizure
medication prescriptions among patients with ESRD with and without a diagnosis of
epilepsy. A modified Poisson regression with a robust variance was used to estimate
the association between epilepsy status and mortality, and evaluate effect modification
by neurology consultation. Additionally antiseizure medications were assessed in relation
to mortality among those with epilepsy. Of 148,294 patients with ESRD in the cohort,
13,094 (8.8%) met a claims-based definition for epilepsy. Among those with epilepsy,
80.9% filled an anticonvulsant or hydantoin prescription in 2013-2014, compared to
33.3% without epilepsy. After adjustment for confounders, the mortality risk among
those with epilepsy was 1.11 (95% confidence interval: 1.07, 1.14) times higher than
those without. An epilepsy diagnosis was associated with a 15% increase in mortality
risk among patients who did not have a neurology consultation (relative risk: 1.15
[95% confidence interval: 1.10, 1.20]), but this risk was attenuated among patients
with a neurology consultation (1.07 [1.03, 1.11]). Prescription of gabapentin to patients
with an epilepsy diagnosis compared to other antiseizure medications was associated
with increased mortality (1.08 [1.01, 1.15]). Thus, patients with ESRD treated with
dialysis have a high prevalence of epilepsy, which was associated with increased mortality
risk compared to those without epilepsy. Hence, appropriate multidisciplinary care,
treatment, and medication selection may reduce mortality among dialysis patients with
epilepsy.
Graphical abstract
Graphical Abstract
Keywords
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Article Info
Publication History
Published online: May 16, 2019
Accepted:
April 25,
2019
Received in revised form:
April 4,
2019
Received:
February 27,
2019
Identification
Copyright
Published by Elsevier, Inc., on behalf of the International Society of Nephrology.
