Baclofen neurotoxicity in uremic patients: is continuous ambulatory peritoneal dialysis less effective than intermittent hemodialysis?

To compare the efficacy between continuous ambulatory peritoneal dialysis (CAPD) and intermittent hemodialysis in the treatment of baclofen-associated neurotoxicity.

Three uremic patients suffering baclofen-associated neurotoxicity were treated by CAPD at our hospital. We obtain 12 cases with detailed clinical course of baclofen-associated neurotoxicity treated by hemodialysis from a literature review using the Medline and Science Citation Index, six of these patients were treated by early hemodialysis which was defined as hemodialysis intervention within 48 h of the onset of clinical toxicity.

Our cases regain full consciousness within 2-3 days after the onset of neurotoxicity. Clinical characteristics of our cases including age, dialysis time, preexisting central nervous system (CNS) lesion, concomitant use of CNS depressant, total baclofen dose, onset of neurotoxicity, and duration of neurotoxicity are not significantly different from reported cases that treated by either early or routine hemodialysis.

Baclofen should be avoided in uremic patients. When consciousness disturbance occurs in uremic patients, baclofen-associated neurotoxicity should be included in the list of differential diagnosis. According to experiences of our patients, we conclude that neither early nor routine hemodialysis is more effective than CAPD in shortening the recovery time of baclofen-associated neurotoxicity.