Dheenan S, Venkatesan J, Grubb B, Henrich WL
Effect of sertraline hydrochloride on dialysis hypotension
NKF 6th Spring Clinical Meeting (Dallas)
Am J Kidney Dis (Apr) 29:A7 1997

In dialysis patients with sudden hypotension, Converse et al have shown that hypotension is associated with an inappropriate reduction in sympathetic efferent nerve traffic (as measured by peroneal neurography). Shinzato et al published a paper in JASN suggesting that this was due to adenosine released from ischemic tissue, and adenosine is a known inhibitor of norepinephrine (NE) release. Shinzato's group claimed they could prevent or abate the effect by giving caffeine predialysis. In rats, caffeine withdrawal exacerbates the hypotensive response to hemorrhagic shock. The normal pharmacologic treatment for this has been to give NE precursors such as DOPS or midodrine . In this abstract, given the fact that serotonin in the CNS may be related to sympathetic efferent activity, Dheenan et al. examined the effect of sertraline, a serotonin reuptake inhibitor, on dialysis-induced hypotension (DH). Rather than an interventional study, they merely collected data on nine HD patients who had been placed on sertraline to treat depression and who also had DH. BP and DH incidence were compared during a 6 week period prior to sertraline and during sertraline therapy. The n of interventions required per dialysis session fell remarkably, from a mean of 11 to 1.7, as did DH epsodes (1.4 to 0.5), and the lowest MAP during dialysis increased. During the sertraline period, dry weight fell by an average of 2.7 kg.

Comment: The results are quite intriguing, and while preliminary, merit a more controlled evaluation of this novel therapeutic approach. (John T. Daugirdas, M.D., Univ of IL at Chicago)

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NKF 6th Spring Clinical Meeting (Dallas)
Basic hemodialysis : Complications (acute)