Effect of Sertraline Hydrochloride on Cardiac Autonomic Dysfunction in Patients with Hemodialysis-Induced Hypotension

Abstract

Background/Aims: It was previously shown that sertraline hydrochloride treatment improved hemodynamic parameters of patients with dialysis induced hypotension (DIH). The aim of this study was to examine the effect of sertraline on the autonomic functions of patients with DIH. Methods: Ten patients with DIH, 10 hemodialysis patients without DIH and 10 healthy control subjects were included into the study. All of the patients were treated with sertraline 50 mg per day for 4 weeks. Pre-treatment and post-treatment heart rate variability (HRV) in supine and tilt position was evaluated. In order to evaluate the autonomic response to tilt position, gap values were calculated by subtracting the HRV in supine position from the HRV in tilt position. Results: Analysis of the HRV response to tilt, demonstrated a paradoxical reduction in the indices of sympathetic modulation and sympathovagal balance in the patients with DIH while there was an increase in normalized powers of low frequency components (LFNU) and low frequency to high frequency components ratio (LFP/HFP) in the patients without DIH and control group. The number of therapeutic interventions for restoration of DIH decreased significantly in the sertraline period (p < 0.001). The gap values of the patients with DIH in LFNU (sympathetic modulation) (p < 0.05) and LFP/HFP (sympathovagal balance) increased in the sertraline period (p < 0.01). The decrease in gap value of normalized powers of high frequency components (parasympathetic modulation) was pronounced in the sertraline period in the patients with DIH (p < 0.05). Conclusion: The preventive effect of sertraline on DIH might be related to the improvement of regulation of autonomic response to hypovolemia.

Acute Complications of Hemodialysis

“…It was demonstrated in many studies that an iv administration of 20 mg/kg during each dialysis reduced the intradialytic hypotension (Perazella, 2001;Lynch et al,2008). There are also studies showing that the use of sertraline, which is a reuptake inhibitor of the selective serotonin, in doses of 50 to 100 mg/day also reduced IDH (Perazella, 2001;Yalcin et al,2003). Midodrine is an α1 agonist.…”

Effects of sertraline in the prevention of low blood pressure in patients undergoing hemodialysis

“…Previous studies have indicated that selective serotonin reuptake inhibitors have improved symptoms in orthostatic hypotension and neurocardiogenic syncope, and have been used as an alternative treatment in patients who develop intradialytic hypotension [23][24][25][26][27][28][29] . Ultrafiltration performed during hemodialysis seems to be the main factor for the activation of the sympathetic reflex and vasoconstriction, which has the purpose of preserving BP at normal levels.…”

The Management of Diabetic Neuropathy in CKD

“…A small study evaluated measures of heart rate variability response to tilt-table testing in dialysis patients with and without DIH and in healthy control subjects. Four-week treatment with 50 mg of sertraline daily induced a paradoxical reduction in indices of sympathetic modulation and sympathovagal balance in patients with DIH while there was an increase in these indices in patients without DIH and in healthy controls, suggesting that the effects of sertraline on DIH might be related to the improvement in the regulation of the autonomic response to hypovolemia 123 . There have been no reported trials of sertraline for cardiac autonomic neuropathy in stage 4-5 CKD patients.…”