Abstracts

Rationale: Epilepsy is a complex neurological condition that can largely impact a patient’s quality of life. With over 30 antiepileptic drugs (AEDs) available for use in the United States, choosing an ideal AED can be difficult and physicians must take into consideration the type of seizures, potential efficacy, comorbidities, and tolerability. A comorbidity in this patient population that further impacts quality of life is end-stage renal disease (ESRD). ESRD is not only a risk factor for the precipitation of seizures due to electrolyte and hypertensive disturbances, but it also further restricts AED options both quantitatively and qualitatively due to the limited data available regarding the safety and efficacy of AEDs in patients requiring hemodialysis (HD), and even less so, peritoneal dialysis (PD). To date, there is only one case report describing the safety and efficacy of an AED in a patient on PD. This case report included the use of levetiracetam in which the patient experienced severe side effects leading to hospitalization. It additionally highlighted the significant pharmacokinetic and pharmacodynamic differences that can occur in patients on PD.¹ As PD offers patients greater flexibility and independence and as advancements in dialysis technology further improve patient tolerability, providers may see more patients on PD, and thus, more data is needed to aid providers in selecting the optimal AED.² The objective of this study was to evaluate the use of AEDs in patients with epilepsy and ESRD on PD.

Methods: Data were obtained from patients with epilepsy (focal or generalized) and ESRD on PD who were seen in the hospital or clinic at the University of Florida – Jacksonville from January 2012 to April 2020. Patients were excluded if they had a history of liver failure. This study was approved by the University of Florida’s Institutional Review Board and all data were collected and managed using the Research Electronic Data Capture (REDCap®).

Results: 23 patients with a history of epilepsy and ESRD on PD were identified. 5 patients were included in the study and summarized in Table 1. Other patients were not included due to not having an epilepsy diagnosis while receiving PD or receiving HD while inpatient during the encounter. Of the 5 patients, 80% were female and 60% were black. The most common etiology of epilepsy was focal symptomatic and the most commonly prescribed medication was levetiracetam. AED levels were collected in 2 of the 5 encounters and were considered to be subtherapeutic. Seizure control was excellent in patients on levetiracetam.

Conclusions: The results of this study highlight the need for additional data focusing on the use of AEDs in ESRD patients on PD. It remains unknown the impact different modes and intensities of PD have on the pharmacokinetic profile of AEDs. Still, in our small cohort, patients on levetiracetam had excellent seizure control suggesting this medication may be a potential option for patients with ESRD receiving HD.

Funding: Please list any funding that was received in support of this abstract.: The authors have no funding or conflicts of interest to disclose.