Impact of chronic kidney disease stage on seizure frequency and severity in pediatric epilepsy patients

BACKGROUND: Chronic Kidney Disease (CKD) and epilepsy are common comorbidities in children; their clinical interaction in terms of seizure frequency and severity has been poorly explored. This study investigates the influence of CKD stage and kidney function markers on seizure outcomes in pediatric epilepsy patients. METHODS: A cross-sectional study was conducted among 250 children aged 2-18 years with biopsy-confirmed CKD and a documented diagnosis of epilepsy. Clinical data were extracted from medical records, including seizure frequency, seizure severity (measured using the National Hospital Seizure Severity Scale, NHS3), serum creatinine, Blood Urea Nitrogen (BUN), and CKD stage. Statistical analyses were performed using SPSS version 26, employing Pearson correlation, one-way ANOVA, and independent samples t-tests to evaluate associations between kidney function, epilepsy etiology, seizure subtype, and seizure outcomes. RESULTS: Significant positive correlations were observed between BUN and both seizure frequency (r = 0.45, p < 0.01) and seizure severity (r = 0.36, p < 0.01). Serum creatinine was similarly correlated with seizure frequency (r = 0.50, p < 0.01) and seizure severity (r = 0.48, p < 0.01). While seizure severity did not differ significantly across CKD stages, ANOVA revealed a significant effect of epilepsy etiology on seizure severity (F(2,247) = 39.45, p < 0.001), with higher severity in metabolic and genetic etiologies compared to structural ones. Additionally, generalized seizures were associated with greater severity than focal seizures (p < 0.001). CONCLUSION: Although seizure severity remained relatively constant across CKD stages, impaired renal function-reflected by elevated BUN and serum creatinine-was strongly associated with increased seizure frequency and severity. These findings suggest that metabolic dysfunction plays a more prominent role than CKD stage in determining seizure burden. Regular monitoring of kidney function markers, consideration of epilepsy etiology, and individualized management strategies integrating nephrological and neurological care may improve outcomes for children with CKD and epilepsy.