Midodrine as a treatment for intradialytic hypotension.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:231A 1997
Hypotension complicates 15 to 50% of all dialysis sessions and often leads to premature termination of dialysis or failure to ultrafilter the requisite amount of water. Autonomic dysfunction with impaired barorereceptor function and paradoxical withdrawal of reflex vasoconstriction have been implicated in the causation of dialysis hypotension.
The authors of this study report on the use of Midodrine, a peripheral alpha adrenergic agonist in hypotension-prone dialysis patients when conventional measures such as sodium modelling, blood pressure medication and target weight adjustments had failed to prevent dialysis-associated hypotension. Midodrine in a dose of 5-10 mg was given 30 minutes before dialysis on 10 occasions and blood pressures compared to readings observed during 10 separate dialysis sessions where Midodrine was not pre-administered.
There was a significant reduction in intradialytic hypotension with Midodrine pre-treatment with lowest systolic/diastolic blood pressure being 114.7 +/- 3.6/59 +/- 2.7 mmhg versus 96.6 +/- 1.6/53.2 +/- 2.4 mmHg with Midodrine. The only adverse effect noted was paraesthesia in one patient. No patient experienced symptoms suggestive of myocardial ischemia.
Comment: If these findings could be reproduced in a larger group of patients, then Midodrine along with hypothermic dialysate and sodium modelling would add to the armamentarium of the practicing nephrologist is treating dialysis-associated hypotension. (Shahab Arfeen, M.D., Valparaiso, IN)
To go back use the BACK button on your browser. Otherwise click on the desired link to this article below:
ASN 30th Annual Meeting, San Antonio
Basic hemodialysis : Complications (acute)