@article{174745f6226a45e09c2a802d72a06cb9,
title = "Recommendations from the EXTRIP workgroup on extracorporeal treatment for baclofen poisoning",
abstract = "Baclofen toxicity results from intentional self-poisoning (acute baclofen poisoning) or accumulation of therapeutic dose in the setting of impaired kidney function. Standard care includes baclofen discontinuation, respiratory support and seizure treatment. Use of extracorporeal treatments (ECTRs) is controversial. To clarify this, a comprehensive review of the literature on the effect of ECTRs in baclofen toxicity was performed and recommendations following EXTRIP methods were formulated based on 43 studies (1 comparative cohort, 1 aggregate results cohort, 1 pharmacokinetic modeling, and 40 patient reports or series). Toxicokinetic data were available for 20 patients. Baclofen's dialyzability is limited by a high endogenous clearance and a short half-life in patients with normal kidney function. The workgroup assessed baclofen as “Moderately dialyzable” by intermittent hemodialysis for patients with normal kidney function (quality of evidence C) and “Dialyzable” for patients with impaired kidney function (quality of evidence C). Clinical data were available for 25 patients with acute baclofen poisoning and 46 patients with toxicity from therapeutic baclofen in kidney impairment. No deaths or sequelae were reported. Mortality in historical controls was rare. No benefit of ECTR was identified in patients with acute baclofen poisoning. Indirect evidence suggests a benefit of ECTR in reducing the duration of toxic encephalopathy from therapeutic baclofen in kidney impairment. These potential benefits were balanced against added costs and harms related to the insertion of a catheter, the procedure itself, and the potential of baclofen withdrawal. Thus, the EXTRIP workgroup suggests against performing ECTR in addition to standard care for acute baclofen poisoning and suggests performing ECTR in toxicity from therapeutic baclofen in kidney impairment, especially in the presence of coma requiring mechanical ventilation.",
keywords = "baclofen, hemodialysis, overdose, pharmacokinetics, poisoning, toxicity",
author = "{EXTRIP workgroup} and Marc Ghannoum and Ingrid Berling and Val{\'e}ry Lavergne and Roberts, {Darren M.} and Tais Galvao and Hoffman, {Robert S.} and Nolin, {Thomas D.} and Andrew Lewington and Kent Doi and Sophie Gosselin and Badria Alhatali and Kurt Anseeuw and Steven Bird and Jos{\'e}e Bouchard and Bunchman, {Timothy E.} and Calello, {Diane P.} and Chin, {Paul K.} and Goldfarb, {David S.} and Hossein Hassanian-Moghaddam and Hoegberg, {Lotte C.} and Siba Kallab and Sofia Kebede and Kielstein, {Jan T.} and King, {Joshua D.} and Yi Li and Macedo, {Etienne M.} and Rob MacLaren and Bruno Megarbane and Mowry, {James B.} and Ostermann, {Marlies E.} and Ai Peng and Roy, {Jean Philippe} and Greene Shepherd and Anitha Vijayan and Walsh, {Steven J.} and Anselm Wong and Wood, {David M.} and Christopher Yates",
note = "Funding Information: TDN reports personal fees from MediBeacon, CytoSorbents, and McGraw-Hill Education, outside the submitted work. MG is a scholar of the Fonds de Recherche du Qu{\'e}bec—Sant{\'e}. DMR acknowledges support from St. Vincent{\textquoteright}s Centre for Applied Medical Research Clinician “Buy-Out” Program. AV reports consulting functions for NxStage, Astute Medical, and Boehringer-Ingelheim and speaker fees from Sanofi-Aventis. EXTRIP received support consisting of an unrestricted grant of $60,633 Canadian from the Verdun Research Fund (the institution of MG) solely for the reimbursement of travel expenses for the in-person guideline meeting and payment to dedicated translators for retrieval and translation of non–English-language articles. All the other authors declared no competing interests. Funding Information: We acknowledge the valuable help of our dedicated translators, librarian, data extractors, and meeting secretary. Official translators were Alexandra Angulo, Alla Abbott, Anant Vipat, Andreas Betz, Angelina Kovaleva, Denise Gemmellaro, Ewa Brodziuk, Helen Johnson, Junzheng Peng, Marcela Covic, Nathalie Eeckhout, Rosie Finnegan, Salih Topal, and Vilma Etchard. The librarian was Elena Guadagno. Data extractors for EXTRIP-2 included Maria Rif, Fran{\c c}ois Filion, Karine Mardini, Maria Rif, Tudor Botnaru, Elizabeth Koo, and Gabrielle Wilson. The meeting secretary was Brenda Gallant. We also acknowledge the participation of our patient representative (name undisclosed). MG, SG, RSH, VL, TDN, and DMR designed the study; IB, MG, SG, RSH, VL, and DMR carried out extractions; IB, MG, and VL made the tables and figures; all authors drafted and revised the article; and all authors approved the final version. Publisher Copyright: {\textcopyright} 2021 International Society of Nephrology",
year = "2021",
month = oct,
doi = "10.1016/j.kint.2021.07.014",
language = "English",
volume = "100",
pages = "720--736",
journal = "Kidney International",
issn = "0085-2538",
number = "4",
}