Effects of ivabradine on the prevention of intradialytic hypotension in a dialytic patient with heart failure with reduced ejection fraction

Abstract

A 65-year-old man with a history of heart failure with reduced ejection fraction (HFrEF) and renal failure was admitted due to difficulty in fluid volume control during haemodialysis. He had frequent episodes of intradialytic hypotension (IDH) with presyncope during haemodialysis despite using a vasopressor agent. Before haemodialysis, his blood pressure was 130–150/60–70 mm Hg, and his heart rate was 80–100 beats/min. There were no specific causes of IDH. For refractory IDH, he was treated with oral ivabradine (2.5 mg two times per day), which resulted in reduced heart rate and decreased occurrence of IDH. This is the first report to describe a dialysis case with HFrEF presenting with an elevated heart rate and impaired fluid management as manifested by recurring IDH, which improved after ivabradine treatment. Ivabradine therapy may assist in increasing stroke volume by lowering the sinus heart rate, thus resulting in the prevention of IDH.

The efficacy and safety of ivabradine hydrochloride in hemodialysis patients with chronic heart failure

“…With a dialysis rate of approximately 10%, it is considered possible to administer the same dose to dialysis patients as to patients with normal renal function. Several case reports on the introduction of ivabradine in hemodialysis patients have shown that it can be safely administered at normal doses [15, 16]. The results of this study suggest that ivabradine can be used safely in hemodialysis patients as well as in patients with chronic kidney disease prior to starting dialysis, showing a reduction in HR.…”

An Updated Review of the Management of Chronic Heart Failure in Patients with Chronic Kidney Disease

“…There is currently little evidence regarding the efficacy of ivabradine in patients with CKD Stage G4-5 or on renal replacement therapy. However, there are a few case reports suggesting patients with HFrEF suffering from intra-hemodialytic hypotension may benefit from ivabradine over beta-blocker [ 166 , 167 ]. They suggest ivabradine may allow for a negative chronotropic effect without a negative inotropic effect, therefore allow a more stable blood pressure during hemodialysis treatment.…”