Low-Dose Dopamine in the Management of Intradialysis Hypotension: A Retrospective Cohort Study in Nigeria

Abstract

Introduction: Intradialytic hypotension (IDH) still remains a common finding in maintenance haemodialysis despite improvements in dialysis delivery. Measures are needed to minimise some aftermath of IDH like dialysis termination, which can impact poorly on dialysis outcome. Methods: This retrospective study assessed IDH in a low-income setting, and compared two cohorts of IDH with and without dopamine treatment. Results: Of the 416 participants, 92 (22.1%) had at least an episode of symptomatic IDH. Of these, 20 (21.7%) were treated with dopamine. Of the 2,205 sessions, 468 (21.2%) had symptomatic IDH, of which 63 (13.4%) with severe IDH were treated with dopamine. The mean age of all participants and dopamine treatment participants were 50.8 ± 9.3 years and 64.6 ± 9.5 years, respectively (P=0.001). Blood pressure (BP) reductions following dialysis were more with females (P=0.04). Dialysis dose was adequate in 7.9% and 4.2% of sessions with and without dopamine (P<0.001). Improvements in glomerular filtration rate were greater in dopamine-treated sessions (P=0.03 and P=0.04, respectively). Fewer anti-hypertensives (aOR: 14.64; 95% confidence interval [CI]: 7.88–20.41), low predialysis systolic (aOR:5.59; 95% CI: 3.88–9.41), and diastolic blood pressure (aOR: 5.78; 95% CI: 4.06-9.81) were independently associated with dopamine-treated sessions. Conclusion: IDH was found in 21.2% of dialysis sessions. 13.4% with severe IDH had dopamine treatment. Participants with dopamine-treated sessions had fewer dialysis terminations and hospitalisations, and dopamine treatment improved the prescribed dialysis and gave higher dialysis doses. Considering the economic effects of dialysis termination in low-income nations, intradialytic dopamine could be very beneficial.