MIDODRINE TREATMENT FOR PATIENTS WITH HEMODIALYSIS HYPOTENSION

Hypotension is the principal complication of chronic hemodialysis. Aut onomic insufficiency is thought to be a primary contributing cause of hemodialysis hypotension. We treated patients who experience hemodialy sis hypotension with midodrine, a selective alpha-1 adrenergic pressor agent in an initial effort to assess potential efficacy. Twenty-one p atients who experienced severe hypotension during hemodialysis partici pated in this study. To qualify, patients had to exhibit a fall of gre ater than or equal to 30 mmHg in systolic blood pressure with associat ed clinical symptoms during hemodialysis. The lowest intra- and post-d ialysis blood pressures were monitored for five consecutive hemodialys is treatment periods before receiving midodrine, as a baseline. After the patients were titrated to a maintenance midodrine dose, the lowest intra- and post-dialysis blood pressure data were again collected for five consecutive dialysis treatments. Hemodialysis blood pressures on midodrine treatment were compared to baseline to evaluate the effect of midodrine. Midodrine given at a mean treatment dose of 8 mg (range 2.5-25) significantly increased the mean (+/- SE) minimal systolic pre ssure from 93.1 +/- 3.8 to 107.1 +/- 3.2 mmHg (p <0.01) and elevated t he mean diastolic pressure from 52.3 +/- 2.9 to 57.9 +/- 2.3 mmHg duri ng hemodialysis. Also, the post-dialysis blood pressures (systolic/dia stolic) were significantly increased from 115.6 +/- 3.1/62.3 +/- 2.1 t o 129.9 +/- 3.9/68.1 +/- 1.7 mmHg (p <0.01 and 0.05, respectively). No apparent clinical or laboratory abnormalities were observed. Oral mid odrine appears to be a safe and effective therapy for the treatment of hemodialysis hypotension.