Sertraline Prevents Hypotension During Hemodialysis: A Randomized Clinical Trial

Abstract

Background: Hemodialysis-induced hypotension is one of the most common problems in patients, who undergo hemodialysis. Evidence suggests the positive impacts of Selective Serotonin Reuptake Inhibitors (SSRIs) on preventing hypotension during dialysis. The current study investigated the hypothesis that sertraline could effectively prevent hypotension during hemodialysis. Methods: In a clinical trial, 30 patients on hemodialysis with hypotension during hemodialysis, who were referred to Tabriz University of Medical Sciences were enrolled. Patients were treated with sertraline at a dose of 50 mg daily for 2 weeks. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate of patients before and after the intervention were measured and compared. Adverse events due to the administration of sertraline were also evaluated in the patients. Results: Of the 30 studied patients, 17 (56.7%) were male and 13 (43.3%) were female. Systolic blood pressure, diastolic blood pressure, and mean arterial pressure increased significantly after sertraline administration (P = 0.001). Also, the mean heart rate of patients significantly decreased (P = 0.001). However, headache was seen in 7 (23.3%), dizziness in 3 (10.0%), and gastrointestinal complications in 2 (6.7%) patients. Conclusions: Based on the results of this study, sertraline effectively and safely prevents hypotension during dialysis without causing serious side effects.

Iatrogenic Errors in Hemodialysis Practices

“…Dialysis hypotension occurs in one of three clinical patterns including episodic (acute) hypotension, which involves a sudden drop of systolic blood pressure below 90 mmHg or at least 20 mmHg alongside clinical symptoms, recurrent hypotension, which also involves drops in systolic blood pressure to similar levels as acute hypotension but prevailing in at least 50% of dialysis sessions and chronic hypotension whereby less than 90-100 mmHg interdialytic systolic blood pressure is maintained [47]. Intradialytic hypotension occurs in 15-30% of conventional dialysis treatments and approximately 35% of other techniques such as therapeutic apheresis [46,48]. The incidence of acute DIH has risen to 50% owing to the increasing number of elder and diabetic patients in the hemodialysis population while that of chronic dialysis hypotension is estimated to occur in 3-5% of dialyzed patients [46].…”

“…Further, dialysis hypotension may result in the collapse of the arterial and venous fistula (AVF) and is an independent risk factor for mortality among hemodialysis patients [49]. The pathophysiology of DIH has been reported to be multifactorial and is associated with both host-related factors like cardiovascular diseases and hemodialysis factors like the volume and velocity of the ultrafiltration fluid [48]. The main contributors to hypotension during dialysis include incorrect calculation of ideal weight (dry weight) for the patients leading to high filtration rates, dialysis with acetate buffer, autonomic neuropathy especially among elderly patients with diabetes, non-biocompatible materials used in the production of dialysis equipment, low sodium and high calcium or high magnesium dialysate concentration, chronic inflammation caused by dialysis, and high dialysate temperature [46,48].…”