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)