ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO1071

Baclofen Usage in Patients with Diminished Kidney Function

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Hasan, Alia, Zucker School of Medicine at Hofstra/Northwell, GREAT NECK, New York, United States
  • Jhaveri, Kenar D., Zucker School of Medicine at Hofstra/Northwell, GREAT NECK, New York, United States
  • Sparks, Matthew A., Duke University and Durham VA Medical Centers, Durham, North Carolina, United States
  • Roberts, John K., Duke University and Durham VA Medical Centers, Durham, North Carolina, United States
  • Kothari, Niraj R., Duke University and Durham VA Medical Centers, Durham, North Carolina, United States
  • Ibrahim, Jamil, Zucker School of Medicine at Hofstra/Northwell, GREAT NECK, New York, United States
  • Makar, Melissa, Duke University and Durham VA Medical Centers, Durham, North Carolina, United States
  • Zaidi, Syed Muhammad raza, Medical University of the Americas, Briarwood, New York, United States
  • Boggan, Joel, Durham VA Medical Center, Durham, North Carolina, United States
  • Hirsch, Jamie S., Zucker School of Medicine at Hofstra/Northwell, GREAT NECK, New York, United States
Background

Baclofen, a muscle relaxant, is primarily excreted via the kidneys. As per pharmacy dosing guidelines, it is contraindicated in paients with eGFR <30cc/min and on dialysis.

Methods

We examined all orders in 2017 for baclofen across 15 hospitals in two large health systems. For each order, we determined the dose and frequency ordered and whether a dose was actually administered. Renal function was determined using the CKD-EPI equation based upon the most proximate serum creatinine at the time of the baclofen order. Presence of dialysis was based upon any order for HD or PD placed during the same visit within 7 days prior to baclofen order.The physician notes were then reviewed from the start date of baclofen administration- 2 days after it was discontinued to see if any new neurological symptoms arose (headache, dizziness, weakness, nausea, vomiting, seizures, lethargy, hallucinations, agitation)

Results

Over 2652 unique orders were placed for baclofen in one health system informatics records. 131 orders were in patients with eGFR <30cc/min (4.9%), 93 (71%) resulted in at least one dose administered to the patient. Similar baclofen usage was seen at second institution with 1182 inpatient unique orders with 95 occurring in patients with eGFR <30cc/min (8%). 86% of the orders were NOT PRN orders, while remaining were PRN orders. Muscle spasms and hiccups were the indications for PRN orders. 46% of the patients- females; 58% -white vs 18% AA; 20% patients were ESKD on dialysis; 8% were incident dialysis patients (required initiation of HD this admission). Most baclofen orders were written by internal medicine (84%) services followed by surgical (7%) and others (4%). 80% of the orders were written by either attendings (50%) or residents (50%), and the remaining 20% by NP/PAs. 42% of the orders led to neurological symptoms findings.

Conclusion

Baclofen was ordered in 5-8% of patients with significantly impaired kidney function. Most baclofen orders were standing medications rather than PRN, and were ordered at high doses, increasing the toxicity risk. A significant percentage of the orders were written by internal medicine physicians. This study highlights the need for an urgent education of renal clearance of several medications such as baclofen to prescribing staff & pharmacists.