Department of Neurology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.
Department of Public Health Sciences, Social & Scientific Systems, Silver Spring, Maryland, USA.
Kidney Int. 2019 Nov;96(5):1176-1184. doi: 10.1016/j.kint.2019.04.033. Epub 2019 May 16.
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.
癫痫与尿毒症有关，但与无癫痫的终末期肾病 (ESRD) 患者相比，有关 ESRD 合并癫痫患者的患病率、治疗和结局的数据较少。在这里，我们使用美国肾脏数据系统进行了一项回顾性队列研究，以评估有和无癫痫诊断的 ESRD 患者的死亡率和抗癫痫药物处方。使用稳健方差的修正泊松回归来估计癫痫状态与死亡率之间的关联，并评估神经病学咨询的效应修饰。此外，还评估了癫痫患者的抗癫痫药物与死亡率之间的关系。在队列中的 148294 名 ESRD 患者中，有 13094 名（8.8%）符合基于索赔的癫痫诊断标准。在癫痫患者中，有 80.9%的人在 2013-2014 年服用了抗惊厥或乙内酰脲处方，而无癫痫的患者比例为 33.3%。在调整混杂因素后，癫痫患者的死亡率风险比无癫痫患者高 1.11 倍（95%置信区间：1.07，1.14）。在未接受神经病学咨询的患者中，癫痫诊断与死亡率风险增加 15%相关（相对风险：1.15 [95%置信区间：1.10，1.20]），但在接受神经病学咨询的患者中，这种风险降低（1.07 [1.03，1.11]）。与其他抗癫痫药物相比，将加巴喷丁处方给癫痫诊断患者与死亡率增加相关（1.08 [1.01，1.15]）。因此，接受透析治疗的 ESRD 患者癫痫患病率较高，与无癫痫的患者相比，死亡率风险增加。因此，适当的多学科护理、治疗和药物选择可能会降低癫痫透析患者的死亡率。
