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Abstract: FR-PO812

Epilepsy and All-Cause Mortality Among ESRD Patients in the US Renal Data System, 2013-2014

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Waddy, Salina, National Institutes of Health, Bethesda, Maryland, United States
  • Ward, Julia B., Social & Scientific Systems, Inc., Durham, North Carolina, United States
  • Powers, Timothy, Social & Scientific Systems, Inc., Durham, North Carolina, United States
  • Eggers, Paul, Retired, Olney, Maryland, United States
  • Abbott, Kevin C., National Institutes of Health, Bethesda, Maryland, United States
  • Williams, Korwyn, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Fwu, Chyng-Wen, Social & Scientific Systems, Inc., Durham, North Carolina, United States
  • Kimmel, Paul L., National Institutes of Health, Bethesda, Maryland, United States
Background

Despite the long-appreciated association of seizures with uremia, there are few national data regarding the prevalence and outcomes of ESRD patients with epilepsy compared to those without epilepsy.

Methods

We assessed claims-based diagnoses of epilepsy, baseline characteristics, anticonvulsant drug prescriptions and outcomes by comparing ESRD patients with and without epilepsy in the USRDS. Study population comprised of prevalent US ESRD patients with continuous Medicare Part A, B, and D coverage from Jan. 1, 2013 to Dec. 31, 2014. Epilepsy was defined as one claim with an International Classification of Disease-9th Revision-Clinical Modification (ICD-9-CM) code for epilepsy or two claims with ICD-9-CM codes for seizures at least 30 days apart from Jan. 1, 2013 to Dec. 31, 2014. The outcome was all-cause mortality from Jan. 1, 2015 to July 31, 2016. We used modified Poisson regression with a robust variance estimator to estimate risk ratios and 95% confidence intervals for the association between epilepsy status and mortality. Final models were adjusted for sociodemographics, ESRD treatment history, and comorbidities.

Results

Of 195,319 ESRD patients in the cohort, 15,233 patients (7.8%) were classified as having epilepsy. Of ESRD patients with a claims-based diagnosis of epilepsy, 80.4% filled an anticonvulsant or hydantoin prescription compared to 31.6% of patients without epilepsy. 19 anticonvulsant medications were prescribed. Levetiracetam and Phenytoin were the most commonly prescribed anticonvulsant drugs without another indication such as pain. 20.1% of patients died during the 19-month follow-up period: 27.9% of patients with epilepsy and 19.4% of patients without epilepsy (p <0.0001). After adjustment for confounders, the estimated mortality risk among those with epilepsy was 1.14 (95% CI: 1.11, 1.18) times that among those without epilepsy.

Conclusion

ESRD patients have a high prevalence of epilepsy and many are treated with anti-convulsant drugs such as Levetiracetam and Phenytoin. ESRD patients with epilepsy had an increased risk of death compared to those without epilepsy. Given the high epilepsy prevalence among the ESRD population, continued efforts are needed to identify appropriate treatment/medication selection and to prevent premature mortality among ESRD patients with epilepsy.

Funding

  • NIDDK Support