Hemodynamics in patients with intradialytic hypotension treated with cool dialysate or midodrine

Hoeben, Heidi; Abu‐Alfa, Ali K.; Mahnensmith, Rex L.; Perazella, Mark A.

doi:10.1053/ajkd.2002.29887

Cited by 50 publications

(50 citation statements)

References 17 publications

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“…Overall, the duration of each trial was short. Eighteen trials reported the effect of cool dialysis on the basis of two sessions of hemodialysis (one session in each arm of the trial) (16,17,21,23,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)41). Three trials evaluated the intervention in three to six hemodialysis sessions (22-24).…”

Section: Study Characteristicsmentioning

confidence: 99%

Effect of Lowering the Dialysate Temperature in Chronic Hemodialysis

Mustafa¹,

Bdair²,

Akl

et al. 2016

Clinical Journal of the American Society of Nephrology

101

110

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Background and objectives Lowering the dialysate temperature may improve outcomes for patients undergoing chronic hemodialysis. We reviewed the reported benefits and harms of lower temperature dialysis.Design, setting, participants, & measurements We searched the Cochrane Central Register, OVID MEDLINE, EMBASE, and Pubmed until April 15, 2015. We reviewed the reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included all randomized, controlled trials that evaluated the effect of reduced temperature dialysis versus standard temperature dialysis in adult patients receiving chronic hemodialysis. We followed the Grading of Recommendations Assessment, Development and Evaluation approach to assess confidence in the estimates of effect (i.e., the quality of evidence). We conducted meta-analyses using random effects models.Results Twenty-six trials were included, consisting of a total of 484 patients. Compared with standard temperature dialysis, reduced temperature dialysis significantly reduced the rate of intradialytic hypotension by 70% (95% confidence interval, 49% to 89%) and significantly increased intradialytic mean arterial pressure by 12 mmHg (95% confidence interval, 8 to 16 mmHg). Symptoms of discomfort occurred 2.95 (95% confidence interval, 0.88 to 9.82) times more often with reduced temperature compared with standard temperature dialysis. The effect on dialysis adequacy was not significantly different, with a Kt/V mean difference of 20.05 (95% confidence interval, 20.09 to 0.01). Small sample sizes, loss to follow-up, and a lack of appropriate blinding in some trials reduced confidence in the estimates of effect. None of the trials reported long-term outcomes.Conclusions In patients receiving chronic hemodialysis, reduced temperature dialysis may reduce the rate of intradialytic hypotension and increase intradialytic mean arterial pressure. High-quality, large, multicenter, randomized trials are needed to determine whether reduced temperature dialysis affects patient mortality and major adverse cardiovascular events.

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Section: Study Characteristicsmentioning

confidence: 99%

Effect of Lowering the Dialysate Temperature in Chronic Hemodialysis

Mustafa¹,

Bdair²,

Akl

et al. 2016

Clinical Journal of the American Society of Nephrology

101

110

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“…Alt ho ugh it has been shown that mi dod ri ne, an oral se lec ti ve alp ha-1 ad re ner gic ago nist, ef fecti vely pre vents hypo ten si on du ring HD in so me recent stu di es, 2,3,8,[16][17][18] only two stu di es ha ve be en re por ted which des cri be its ef fects on HD pa ti ents with chro nic hypo ten si on. 5,9 This disagreement may be re la ted to cha rac te ris tics of the pa ti ent popu la ti on, study de sign and the do se of mi dod ri ne given.…”

Section: Discussionmentioning

confidence: 99%

“…2 He mody na mi cally, chro nic hypo ten si on is cha rac te ri zed by pre ser ved car di ac in dex, he art rate or stro ke vo lu me, but re du ced to tal pe rip he ral vas cu lar re sis tan ce. 3 Alt ho ugh its pat hoph ysi o logy is not well de fi ned, a re du ced car di o vas cu lar respon se to va sop res sor agents (such as no re pi nep hrine and an gi o ten sin II) re la ted to down-re gu la ti on of the ir re cep tors, as well as an in cre a sed pro duc tion of va so di la tors (such as nit ric oxi de or ad re nome dul lin) are pos sibly in vol ved. 4 Va ri o us signs and symptoms as so ci a ted to HD hypo ten si on are numbness of the ex tre mi ti es, diz zi ness, ge ne ral fa ti gu e, epi gas tric dis com fort, fa in ting, swe a ting, yaw ning, vo mi ting, in con ti nen ce and even occ lu si on of the ar te ri o ve no us fis tu la.…”

mentioning

confidence: 99%

The Effect of Midodrine Hydrochloride on Chronic Hypotension in Patients with Diabetes Mellitus Undergoing Hemodialysis Therapy

Sarikaya¹,

Sarı²,

Güneş³

2011

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: Chro nic hypo ten si on is a com mon comp li ca ti on of he mo di aly sis in pa ti ents with di a be tes mel li tus. Mi dod ri ne hydroch lo ri de is an alp ha-1 ago nist that ef fec ti vely cor rects intra di aly tic hypo ten si ve at tacks. However, the ef fect of mi dod ri ne on chro nic hypo ten si on is still unk nown in he mo di aly sis pa ti ents. In the pre sent study, we ai med to eva lu a te the ef fects of mi dod ri ne tre at ment on chro nic hypo ten si on in pa ti ents with di a be tes mel li tus undergoing he mo di aly sis. M Ma a--t te e r ri i a al l a an nd d M Me et t h ho od ds s: A to tal of 21 di a be tic pa ti ents un der go ing he mo di aly sis and had chro nic hypo ten si on (systo lic blo od pres su re <100 mmHg be fo re di aly sis) we re inc lu ded in the study. Mi dod ri ne was given 5 mg p.o. twi ce a day and 5 mg be fo re every di aly sis ses si on to all pa ti ents. Blo od pres su res (pre-he mo di aly sis systo lic, di as to lic and me an ar te ri al pres su re) we re me a su red. In tra-di aly tic hypo ten si on at tacks, ort hos ta sis, diz zi ness, fa ti gu e, blur red vi si on, dull ness, and he a dac he we re re cor ded. Da ta ob ta i ned be fo re mi dod ri ne the rapy we re com pa red to tho se collec ted at the 3 rd month of he mo di aly sis when the patients were under mi dod ri ne the rapy. R Re e s su ul lt ts s: : Pre-di aly sis systo lic, di as to lic and me an ar te ri al blo od pres su res, ver ti go and synco pe at tacks were sig ni fi cantly (p< 0.05) im pro ved by mi dod ri ne the rapy. No sig ni fi cant dif fe ren ce was se en in mean ul tra-fil tra ti on vo lu me per he mo di aly sis ses si on and num ber of in tra-di aly tic hypo ten si ve at tacks ac cor ding to ba se li ne va lu es over the co ur se of study (p>0.05). C Co on nc c l lu u s si i o on n: : Mi dod ri ne ap pe ars to be an ef fec ti ve and sa fe tre at ment op ti on in di a be tic he mo di aly sis pa ti ents with sympto ma tic chro nic hypo ten si on, but it has no ef fect on in tra-di aly tic hypo ten si ve at tacks. K Ke ey y W Wo or rd ds s: : Di a be tes mel li tus; hypo ten si on; re nal di aly sis; Mi dod ri ne Ö ÖZ ZE ET T A Am ma aç ç: Kro nik hi po tan si yon di ya bet li has ta lar da he mo di ya li zin sık gö rü len bir komp li kasyo nu dur. Mi dod rin hid rok lo rid di ya liz sı ra sın da ki hi po tan sif atak la rı et ki li şekil de dü zel ten al fa-1 ago nist bir ilaç tır. Fa kat he mo di ya liz has ta la rın da mi dod ri nin kro nik hi po tan si yon da ki et ki si ha len bi lin me mek te dir. Bu ça lış ma da mi dod rin te da vi si nin he mo di ya liz te da vi si alan di ya bet has ta la rın -da kro nik hi po tan si yo na et ki le ri ni de ğer len dir me yi amaç la dık. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: Kro nik hi potan si yo nu olup (di ya liz den ön ce sis to lik kan ba sın cı <100 mmHg) he mo di ya liz te da vi si alan top lam 21 di ya be tik has ta ça lış ma ya alın dı. Tüm has ta la ra gün de iki kez ...

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“…Midodrine is a prodrug that when metabolized acts as an alpha-1-receptor agonist. It can provide modest increases in both peripheral vascular resistance and cardiac output [46]. It is a well-tolerated medication with the most common side effects being piloerection, scalp itching/burning and nausea.…”

Section: Treatment For Intradialytic Hypotensionmentioning

confidence: 99%