Comparing Seizure Risk Between Peritoneal Dialysis and Hemodialysis

We read with interest the article by Titoff et al1 that described factors related to the development of seizures in patients with chronic kidney disease. The authors provided valuable observations of each antiepileptic drug (AED), including the need for adjustment in patients on hemodialysis (HD) therapy. However, we have noted in our service that patients with epilepsy who switched from peritoneal dialysis (PD) to HD therapy experienced an increase in seizures. Although the authors observed that acute seizures caused by disequilibrium syndrome are rare due to improved dialysis techniques, there are still several reasons to justify the need for a comparison of the risk for seizures between PD and HD: (1) patients on HD therapy are particularly prone to seizures due to faster clearance from the blood compared to cerebral spinal fluid and they also have a higher chance of hypotension and electrolyte disequilibrium; (2) although most AEDs should be supplemented after HD due to high clearance, PD in general provides low drug clearance; and (3) for most AEDs regularly used in clinical practice, there are no specific data for management on PD therapy.

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