Use of Sertraline in Hemodialysis Patients

Abstract

Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control.

The effectiveness of sertraline in alleviating uremic pruritus in hemodialysis patients: a randomized clinical trial

“…Also, no major adverse event, bleeding, new sexual complaint, nor QT interval prolongation were reported in the sertraline group. These findings support the data [ 17 ] suggesting that sertraline is considered a relatively safe antidepressant in dialysis patients with fewer side effects compared to other drugs.…”

“…Sertraline hydrochloride is a SSRI which improved itching in patients with cholestatic pruritus [ 16 ]. Compared to other SSRI, sertraline is considered a safe and effective option for the treatment of depression and anxiety in ESRD patients [ 17 ]. There is paucity of data regarding effects of sertraline on UP.…”

Psychosocial Aspects in Hemodialysis

“…Among the SSRIs, fluoxetine is the most researched, with a daily dose of 20-60 mg considered tolerable [16,68]. Another review has focused on the use of sertraline in hemodialysis and found that the use of sertraline appears to be safe but needs more investigation [69]. A double-blind randomized clinical trial found that sertraline has improved pruritis intensity in hemodialysis patients [70].…”

New TLC Method Combined with Densitometry for Determination of Sertraline and Fluoxetine in Pharmaceutical Preparations

“…The disease affects about 3-5% of the world's population, and more often it affects women, but the mechanism of its development has not been fully understood [1]. At the same time, the presence of a somatic disease such as Parkinson's disease, pain syndromes, malignant tumors, thyroid diseases, diabetes, heart attack, stroke, ischemic heart disease, AIDS, and Alzheimer's disease, may increase the likelihood of a depressive episode [2][3][4][5][6][7][8][9].…”

“…Fluoxetine and sertraline belong to the SSRIs, and in addition to the treatment of depression, they also find a number of other applications, including in the treatment of anxiety disorders, eating disorders, and alcoholism [1]. Fluoxetine and sertraline may also be administered as an adjunct to cancer pain management together with essential pain relievers [1][2][3]. Fluoxetine is a frequently prescribed antidepressant and is also used in bulimia nervosa, where it reduces bulimic and depressive symptoms [10].…”