Managing the patient with epilepsy and renal impairment

Sherif Hanafy Mahmoud; Xiao Ying Zhou; S Nizam Ahmed

doi:10.1016/j.seizure.2020.02.006

Managing the patient with epilepsy and renal impairment

Seizure. 2020 Feb 10:76:143-152. doi: 10.1016/j.seizure.2020.02.006. Online ahead of print.

Authors

Sherif Hanafy Mahmoud¹, Xiao Ying Zhou², S Nizam Ahmed³

Affiliations

¹ Clinical Associate Professor, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada. Electronic address: smahmoud@ualberta.ca.
² Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.
³ Professor of Medicine (Neurology) and Director, Clinical Neurophysiology Laboratory, Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

PMID: 32087549
DOI: 10.1016/j.seizure.2020.02.006

Abstract

Purpose: Epilepsy affects more than 50 million people worldwide and its management can be complicated by comorbidities such as impaired renal function. To optimize epilepsy control in patients with kidney disease, clinicians need to be aware of how antiepileptic drugs (AEDs) are affected by impaired renal function and how the kidneys are affected by epilepsy management strategies. Herein we present a narrative review with systematic literature search to discuss the use of AEDs in patients with renal impairment, including those undergoing dialysis, as well as the nephrotoxic effects of some AEDs. We finally conclude the article by providing practical tips about our approach to using AEDs in the setting of renal disease.

Methods: A literature search targeting epilepsy management in patients with kidney disease was performed in MEDLINE database (1946 to 7^th Jan 2019).

Results: A total of 1193 articles were found. After duplicate removal, title and abstract screening followed by full text screening, a total of 110 references were included in this review. Additional information was included from drug product monographs.

Conclusion: The disposition of AEDs can be altered in patients with impaired renal function, leading to a higher risk of AED toxicity or therapy failure. Renal dosage adjustment and close monitoring is recommended. Although AED-induced nephrotoxicity is rare, it is unpredictable and clinicians need to vigilant about this possibility. In addition, AEDs renal adverse reactions and renal drug interactions should be considered when selecting an AED.

Keywords: Antiepileptic drugs; Epilepsy; Kidney disease; Renal impairment.

Publication types

Review