Pharmacologic options available to treat symptomatic intradialytic hypotension

Acute Complications of Hemodialysis

“…Therefore, a medical treatment may be considered for the patients with increased hypotension episodes in spite of all these measures. The treatment agents that were evidenced to have positive effects in pharmacologic therapy are carnitine, sertraline and midodrine (Perazella, 2001). L-carnitine is a naturally available amino acid and assumes the duty of carrying longchain fatty acids to the mitochondria.…”

“…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.…”

“…Midodrine is an α1 agonist. Hypotension was shown to be reduced with its use 30 minutes before hemodialysis (the initial dose of 2.5 mg is increased to 30 mg by titration) in patients with IDH (Perazella, 2001;Cruz et al,1997).…”

Serum Vasopressin Response in Patients With Intradialytic Hypotension

“…Also, neurally mediated vasopressor syncope could contribute. Current therapeutic modalities for managing IDH include sodium modeling, intravenous mannitol, midodrine, and cool dialysate; however, these measures have been used with variable success and associated risks (7)(8)(9)(10)(11)(12)(13).…”

Arterial Hypotension in Patients on Peritoneal Dialysis

“…Additional therapeutic measures may include the administration of antihypotensive drugs such as ephedrine, fludrocortisone and midrodrine, which are efficacious, well tolerated, safe and easy to administer (27)(28)(29)(30). In a few patients who responded, midodrine in a dose of 7.5 mg/day in three divided doses of 2.5 mg gave a 20-25 mmHg increase in blood pressure (three patients responded and four did not) (10,11).…”