Iatrogenic Baclofen Neurotoxicity in ESRD: Recognition and Management.

Abstract:

:Baclofen is an oral derivative of gamma-aminobutyric acid (GABA) used to treat muscular spasticity from disorders of the central nervous system. However, it is also being used for a variety of other conditions such as musculoskeletal pain, myoclonus, and alcohol withdrawal. The elimination of baclofen is heavily dependent on intact renal function, and the contraindication for use in patients with insufficient renal function is not well recognized by healthcare providers. Here, the authors report a series of mild to severe cases of baclofen intoxication in patients with end-stage renal disease. In all cases, baclofen was initiated by either inpatient or outpatient healthcare providers and the patients generally presented with altered mentation, somnolence, and/or respiratory depression. All patients were treated with aggressive hemodialysis and made a full recovery. This paper will briefly review the literature regarding baclofen intoxication, safety of baclofen use in renal disease, and efficacy of extracorporeal therapy in the treatment of baclofen intoxication.

journal_name

Semin Dial

journal_title

Seminars in dialysis

authors

Roberts JK,Westphal S,Sparks MA

doi

10.1111/sdi.12400

subject

Has Abstract

pub_date

2015-09-01 00:00:00

pages

525-9

issue

5

eissn

0894-0959

issn

1525-139X

journal_volume

28

pub_type

信件
  • Metastatic complications of bloodstream infections in hemodialysis patients.

    abstract::Bacteremia is a common infectious complication in hemodialysis patients. Metastatic sites of infection including infective endocarditis, vertebral osteomyelitis, spinal epidural abscess, and septic arthritis occur relatively frequently. These complications are associated with increased morbidity and mortality in hemod...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/sdi.12031

    authors: Lewis SS,Sexton DJ

    更新日期:2013-01-01 00:00:00

  • Doppler ultrasound: a powerful tool for vascular access surveillance.

    abstract::National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines recommend Doppler ultrasound (DU) for surveillance of vascular access (VA), but trials have not been unanimous about its benefit on VA patency. The aim of this study was to evaluate the accuracy of DU for patency, as well as t...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章

    doi:10.1111/sdi.12334

    authors: Guedes Marques M,Ibeas J,Botelho C,Maia P,Ponce P

    更新日期:2015-03-01 00:00:00

  • Assessing the Adequacy of Small Solute Clearance for Various Dialysis Modalities, with Inclusion of Residual Native Kidney Function.

    abstract::Measurement of small molecule clearance remains important in the clinical care of patients requiring long-term dialysis. Many patients maintain a significant degree of residual native kidney function and may have nontraditional schedules with or without combined dialysis modalities. In this review, we examine and outl...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/sdi.12584

    authors: Chin AI,Depner TA,Daugirdas JT

    更新日期:2017-05-01 00:00:00

  • Past, present, and future of quantified peritoneal dialysis.

    abstract::The role of peritoneal dialysis (PD) as a modality in renal replacement therapy has been well established. In this article we review various aspects in the evolution of PD, with special emphasis on adequacy. Until the late 1950s PD was still considered as a last resort in the treatment of terminal uremia. The introduc...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1046/j.1525-139x.2001.00071.x

    authors: Haq NU,Nolph KD

    更新日期:2001-07-01 00:00:00

  • Are Diuretics Underutilized in Dialysis Patients?

    abstract::While oral diuretics are commonly used in patients with chronic kidney disease for the management of volume and blood pressure, they are often discontinued upon initiation of dialysis. We suggest that diuretics are considerably underutilized in peritoneal dialysis and haemodialysis patients despite numerous potential ...

    journal_title:Seminars in dialysis

    pub_type: 社论

    doi:10.1111/sdi.12483

    authors: Trinh E,Bargman JM

    更新日期:2016-09-01 00:00:00

  • Addressing myths about exercise in hemodialysis patients.

    abstract::Despite decades of research, there are few published guidelines related to the safety and efficacy of exercise training in hemodialysis patients. This has led to disparate recommendations regarding the type, intensity, and timing for exercise, especially for patients with multiple comorbidities. Many common recommenda...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/sdi.12815

    authors: Wilund KR,Jeong JH,Greenwood SA

    更新日期:2019-07-01 00:00:00

  • Coronary-subclavian steal syndrome in a hemodialysis patient, a case report and review of literature.

    abstract::Dialysis vascular access associated coronary-subclavian steal or hypoperfusion syndrome is an uncommon but potentially life threatening condition. Awareness of this syndrome is important in the management of vascular access in hemodialysis patients. We report a case of dialysis vascular access associated coronary-subc...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/sdi.12077

    authors: Tan CS,Fintelmann F,Joe J,Ganguli S,Wu S

    更新日期:2013-09-01 00:00:00

  • Dialysate leaks in peritoneal dialysis.

    abstract::Dialysate leakage represents a major noninfectious complication of peritoneal dialysis (PD). An exit-site leak refers to the appearance of any moisture around the PD catheter identified as dialysate; however, the spectrum of dialysate leaks also includes any dialysate loss from the peritoneal cavity other than via the...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1046/j.1525-139x.2001.00014.x

    authors: Leblanc M,Ouimet D,Pichette V

    更新日期:2001-01-01 00:00:00

  • Percutaneous and surgical insertion of peritoneal catheter in patients starting in chronic dialysis therapy: a comparative study.

    abstract::Percutaneous peritoneal catheter insertion can be performed by trained nephrologists. The objective of this study was to compare the outcome of peritoneal dialysis (PD) catheters percutaneous inserted with the traditional surgical technique. One hundred twenty-one PD catheters were placed in 121 stage-5 Chronic kidney...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章

    doi:10.1111/sdi.12147

    authors: Chula DC,Campos RP,de Alcântara MT,Riella MC,do Nascimento MM

    更新日期:2014-05-01 00:00:00

  • Do ketoanalogues still have a role in delaying dialysis initiation in CKD predialysis patients?

    abstract::Early versus later start of dialysis is still a matter of debate. Low-protein diets have been used for many decades to delay dialysis initiation. Protein-restricted diets (0.3-0.6 g protein/kg/day) supplemented with essential amino acids and ketoanalogues (sVLPD) can be offered, in association with pharmacological tre...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/sdi.12132

    authors: Aparicio M,Bellizzi V,Chauveau P,Cupisti A,Ecder T,Fouque D,Garneata L,Lin S,Mitch W,Teplan V,Yu X,Zakar G

    更新日期:2013-11-01 00:00:00

  • Starting a home hemodialysis program.

    abstract::Home hemodialysis is not a new therapy; rather it is a therapy in which interest has been rekindled due to both the continually growing end-stage renal disease population and concern about poor outcomes in patients on conventional thrice-weekly in-center dialysis. The practical issues to be considered when starting a ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/j.1525-139X.2007.00239.x

    authors: Moran J,Kraus M

    更新日期:2007-01-01 00:00:00

  • Obesity as a barrier to kidney transplantation: Time to eliminate the body weight bias?

    abstract::There is clear evidence that survival rates following transplantation far exceed those for remaining on dialysis, regardless of body size measured by body mass index (BMI). Studies over the past 15 years also suggest little to no difference in long-term outcomes, including graft survival and mortality, irrespective of...

    journal_title:Seminars in dialysis

    pub_type: 社论

    doi:10.1111/sdi.12783

    authors: MacLaughlin HL,Campbell KL

    更新日期:2019-05-01 00:00:00

  • Cardiovascular abnormalities and hypertension in the elderly dialysis patient.

    abstract::Elderly individuals comprise an ever-increasing proportion of patients on renal replacement therapy (RRT). As in younger patients, cardiovascular events are the major cause of death in the elderly on RRT, although the relative proportion succumbing to cardiovascular events is similar to that in young patients. An impo...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1046/j.1525-139x.2002.00037.x

    authors: Dikow R,Zeier M,Ritz E

    更新日期:2002-03-01 00:00:00

  • We Do Too Many Parathyroidectomies for Calciphylaxis.

    abstract::Calciphylaxis, a disorder of dermal arteriolar calcification with a distinct predilection for patients with advanced kidney disease, remains an enigmatic condition that challenges clinicians. Observations regarding positive associations between levels of circulating parathyroid hormone (PTH) and the risk of calciphyla...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章

    doi:10.1111/sdi.12502

    authors: Nigwekar SU,Sprague SM

    更新日期:2016-07-01 00:00:00

  • Blood pressure control in conventional hemodialysis.

    abstract::Hypertension among patients on hemodialysis is common, difficult to diagnose and often inadequately controlled. Although specific blood pressure (BP) targets in this particular population are not yet established, meta-analyses of randomized trials showed that deliberate BP-lowering with antihypertensive drugs improves...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/sdi.12741

    authors: Georgianos PI,Agarwal R

    更新日期:2018-11-01 00:00:00

  • Percutaneous retrieval of an intravascular fluency stent-graft using a rigid alligator forceps: case report.

    abstract::The author reports a case of a successful retrieval of a stent-graft in a young patient with a femoral dialysis graft. The stent-graft was used to treat a resistant occluded segment of the arterial limb of the graft. However, the stent-graft was inadvertently deployed partially into the superficial femoral artery. The...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章

    doi:10.1111/j.1525-139X.2010.00710.x

    authors: Alomari AI

    更新日期:2010-03-01 00:00:00

  • Prevention and treatment of hemodialysis-related bloodstream infections.

    abstract::Despite improvements in the delivery of care, the annual all-cause mortality rate for end-stage renal disease (ESRD) patients is still around 220 deaths per 1000 at risk patient-years. Infection-related causes are second only to cardiovascular events as a cause for mortality among ESRD patients. Almost two-thirds of a...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/sdi.12117

    authors: Camins BC

    更新日期:2013-07-01 00:00:00

  • Ultrapure dialysate: a desirable and achievable goal for routine hemodialysis.

    abstract::United States standards for the microbiologic quality of dialysate are not very stringent and have remained unchanged for more than 20 years, despite significant changes in the patient population and in the technology of hemodialysis. Numerous studies have demonstrated that bacterial products can cross dialysis membra...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章

    doi:10.1046/j.1525-139x.2000.00103.x

    authors: Ward RA

    更新日期:2000-11-01 00:00:00

  • We Wait Too Long to Refer Patients for Transplantation.

    abstract::Late referral of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) for evaluation of kidney transplantation is common. Even though renal transplantation offers a clear survival benefit to patients with advanced CKD and ESRD and should be considered the renal replacement therapy of choice, n...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章

    doi:10.1111/sdi.12497

    authors: Peev V

    更新日期:2016-07-01 00:00:00

  • Extracorporeal treatment of cast nephropathy.

    abstract::Acute kidney injury (AKI) is common in patients with multiple myeloma (MM), most commonly caused by cast nephropathy resulting from precipitation of free light chains (FLC) in renal tubules. AKI may be irreversible and require dialysis and predicts a poor prognosis. Reduction in serum FLC concentration is thought to b...

    journal_title:Seminars in dialysis

    pub_type: 社论

    doi:10.1111/j.1525-139X.2010.00814.x

    authors: Gakhar B,Kobrin S,Berns JS

    更新日期:2011-01-01 00:00:00

  • The other side of the coin: impact of toxin generation and nutrition on the uremic syndrome.

    abstract::Both the morbidity of the uremic syndrome and the generation of uremic toxins are attributed to malnutrition. If protein intake and catabolism result in the generation of solutes, then nutritional intake should be related directly to toxicity. On the other hand, inadequate nutrition has been linked to inflammation and...

    journal_title:Seminars in dialysis

    pub_type: 社论

    doi:10.1046/j.1525-139x.2002.00076.x

    authors: Vanholder R,Glorieux G,Lameire N

    更新日期:2002-09-01 00:00:00

  • The impact of arteriovenous fistulae on the myocardium: the impact of creation and ligation in the transplant era.

    abstract::Cardiac hypertrophy is a relatively common complication seen in patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD). Moreover, cardiac hypertrophy is even more frequently seen in patients with ESRD who have an arteriovenous (AV) access. There has been substantial evidence pertaining ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/sdi.12313

    authors: Duque JC,Gomez C,Tabbara M,Alfonso CE,Li X,Vazquez-Padron RI,Asif A,Lenz O,Briones PL,Salman LH

    更新日期:2015-05-01 00:00:00

  • Longitudinal assessment of hemodynamic endpoints in predicting arteriovenous fistula maturation.

    abstract::Arteriovenous fistula (AVF) nonmaturation is currently a significant clinical problem; however, the mechanisms responsible for this have remained unanswered. Previous work by our group and others has suggested that anatomical configuration and the corresponding hemodynamic endpoints could have an important role in AVF...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章

    doi:10.1111/j.1525-139X.2012.01112.x

    authors: Rajabi-Jagahrgh E,Krishnamoorthy MK,Roy-Chaudhury P,Succop P,Wang Y,Choe A,Banerjee RK

    更新日期:2013-03-01 00:00:00

  • Blood Pressure Management in Hemodialysis Patients: What We Know And What Questions Remain.

    abstract::Despite having thousands of blood pressure (BP) readings on individual dialysis patients over the course of a year, our knowledge about the optimal assessment of BP, the mechanisms underlying hypertension and its management remain incomplete. Observational studies reveal that BP is lower at home than when measured in ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/sdi.12586

    authors: Miskulin DC,Weiner DE

    更新日期:2017-05-01 00:00:00

  • Anemia management in cancer patients with chronic kidney disease.

    abstract::Cancer and kidney disease are linked by causality and comorbidities. Observational data show an increased risk of malignancy as renal function declines. Erythropoietin stimulating agents (ESAs), which are the cornerstone therapy for anemia patients with chronic kidney disease and cancer, are associated with increased ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/sdi.12841

    authors: Latcha S

    更新日期:2019-11-01 00:00:00

  • A survey of current procedural practices of Australian and New Zealand nephrologists.

    abstract::The aim of this study was to describe the range and extent of current procedural practices of Nephrologists and trainees in Australia and New Zealand with a specific focus on renal biopsy. A web-based survey was constructed based on a 2009 pilot survey conducted by the authors. The survey was distributed by email. A t...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章

    doi:10.1111/sdi.12072

    authors: Ritchie AG,Saunders J,Baer R,May S,Australian and New Zealand Special Interest Group in Interventional Nephrology Research Collaboration.

    更新日期:2013-11-01 00:00:00

  • Comparison of peritoneal dialysis catheter insertion techniques by nephrologists: Surgical vs blind methods.

    abstract:BACKGROUND:The aim of the present study was to perform a comparative analysis of peritoneal dialysis catheter (PDC) insertion between blind and surgical methods by nephrologists. PATIENTS AND METHODS:The present study enrolled 249 peritoneal dialysis patients who received first-time PDC insertion. All PDC insertions w...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章

    doi:10.1111/sdi.12904

    authors: Kang SH,Park JW,Cho KH,Do JY

    更新日期:2020-07-23 00:00:00

  • Mycotic aneurysms and death in a hemodialysis patient.

    abstract::A patient with newly diagnosed end-stage renal disease (ESRD) received a femoral catheter for hemodialysis (HD). Shortly thereafter he developed fever, and blood cultures grew methicillin-resistant Staphylococcus aureus. The catheter was removed and the patient was treated with both vancomycin and rifampin; however, b...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章

    doi:10.1111/j.1525-139X.2005.18323.x

    authors: Chang CS,Thajeb P,Chen HH,Wu CJ

    更新日期:2005-07-01 00:00:00

  • Management of hyperkalemia in dialysis patients.

    abstract::Hyperkalemia is common in patients with end-stage renal disease, and may result in serious electrocardiographic abnormalities. Dialysis is the definitive treatment of hyperkalemia in these patients. Intravenous calcium is used to stabilize the myocardium. Intravenous insulin and nebulized albuterol lower serum potassi...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审

    doi:10.1111/j.1525-139X.2007.00312.x

    authors: Putcha N,Allon M

    更新日期:2007-09-01 00:00:00

  • Central vein hardware: cannot live with it, cannot live without it.

    abstract::Central vein catheters for dialysis have become an integral and unavoidable access modality for providing hemodialysis therapy despite all their major drawbacks. We report a clinical decision dilemma that every nephrologist will encounter while considering an ideal dialysis access for the steadily aging dialysis popul...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章

    doi:10.1111/j.1525-139X.2008.00475.x

    authors: Vachharajani TJ,Moossavi S,Kaufman T,Rocco M

    更新日期:2009-09-01 00:00:00