Sertraline Hydrochloride Treatment for Patients with Hemodialysis Hypotension

Abstract

Background: Recently some pathogenetic parallels have been drawn between dialysis-induced hypotension and disorders characterized by hemodynamic instability due to autonomic dysfunction, such as neurocardiogenic syncope and idiopathic orthostatic hypotension. Several studies have shown that central serotonergic pathways participate in the abnormal response, and selective serotonin reuptake inhibitors improve the symptoms of patients with neurocardiogenic syncope or idiopathic orthostatic hypotension. In order to evaluate the effectiveness of sertraline on dialysis-induced hypotension a prospective study was designed. Methods: The data of 9 patients from a 4-week pre-sertraline period were compared with the data of a 4-week sertraline (100 mg daily) period. The therapeutic effect of sertraline requires 4 weeks. Therefore the sertraline period was begun 4 weeks after starting the drug. Results: Post-hemodialysis weights and ultrafiltration volumes were similar in the pre-sertraline and sertraline periods. There were also no changes in hematocrit and serum albumin. Both systolic and diastolic blood pressure before dialysis remained unchanged during sertraline treatment. The nadir systolic blood pressure and systolic blood pressure after dialysis increased significantly in the sertraline period. The nadir diastolic pressure was also increased significantly but the increase in post-dialysis diastolic blood pressure did not reach statistical significance. The necessity of therapeutic interventions per dialysis session decreased significantly in the sertraline period compared with pre-sertraline period. Conclusions: This pilot study has shown that sertraline has the potential to be a safe and effective therapy for dialysis hypotension. Long-term clinical and pathophysiological studies are currently in progress.

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

“…The data of this study supported the result of our previous study and confirmed that sertraline, after a 4-week course of treatment, effectively prevents DIH in patients with episodes of symptomatic DIH in more than 50% of HD treatments [21]. Optimum dry weights and cardiac status of these patients were well evaluated to exclude excess UF and cardiac diseases.…”

“…However, most of these drugs have been modestly effective or poorly tolerated [26]. Our studies demonstrate that sertraline is a useful alternative to prevent DIH in the patients having hypotension despite institution of the dialysate with high sodium and cool temperature [21]. Sertraline hydrochloride, a selective central serotonin re-uptake inhibitor, is a well-known antidepressant drug and it can be used in the patients with end-stage renal failure without dose reduction.…”

“…Despite the common side effects of sertraline such as dizziness, insomnia, fatigue, somnolence and headache, all of which are not life threatening, it could be accepted as a safe drug [23]. However, it was reported that 25% of the patients treated by 100 mg sertraline per day could not tolerate the treatment due to side effects [21]. In this study, a lower dosage of sertraline (50 mg/day) was used and any side effect necessitating the cessation of therapy were not observed.…”

“…Several studies have shown that central serotonergic pathways participate in the abnormal response and the selective serotonin re-uptake inhibitors improve the symptoms of the patients with neurocardiogenic syncope or idiopathic orthostatic hypotension [16, 17, 18, 19, 20]. In addition, a retrospective study by Dheenan et al [15] and our previous prospective study [21] have shown that treatment with sertraline hydrochloride, a serotonin re-uptake inhibitor, was associated with an improvement in the hemodynamic parameters of patients with DIH during hemodialysis.…”

Monoaminergic‐based Pharmacotherapy for Depression

“…Treatment of depression in hemodialysis patients with fluoxetine appears safe, yielding fluoxetine and norfluoxetine blood levels comparable to those of patients with normal renal function (Blumenfield et al, 1997;Levy et al, 1996), and more effective than placebo in the treatment of depression (Blumenfield et al, 1997). In fact, the fluoxetine and sertraline may also be beneficial with regard to alleviating postural hypotension in dialysis patients, present in up to 50% of patients with end-stage renal disease (Chin et al, 1996;Yalcin et al, 2002). The use of citalopram for the treatment of depression in patients with hepatitis C also appears not to reduce levels of aspartate aminotransferase, alanine aminotransferase, or γ-glutamyltransferase (Gleason et al, 2002).…”