Department of Internal Medicine, Louisiana State University Health, Shreveport, LA, USA.
Division of Cardiovascular Medicine, Brigham and Women's Hospital Heart & Vascular Center, Boston, MA, USA.
Acta Cardiol. 2024 Jul;79(5):545-548. doi: 10.1080/00015385.2024.2365608. Epub 2024 Jun 11.
Midodrine, an FDA-approved medication for orthostatic hypotension, is also used off-label to manage hypotension in dialysis patients, including those with heart failure. However, in patients with reduced ejection fraction (HFrEF) and/or right heart failure, midodrine is potentially harmful. No known studies examine the safety of midodrine in hospitalised kidney failure patients with HF.
The TriNetX database was queried for hospitalised kidney failure patients with HFrEF and/or right heart failure who experienced hypotension (SBP < 110 mm Hg or MAP < 70 mm Hg). Excluding those needing critical care or vasopressors, we compared cohorts based on midodrine use, matching for comorbidities.
Analysis showed patients on midodrine had a higher 6-month mortality risk ratio (RR 1.53, 95% CI 1.037 to 2.246) and Hazard Ratio (HR 1.54, 95% CI 1.022 to 2.317) compared to those not on midodrine, indicating an association with increased mortality.
This study illuminates the complexities in treating hospitalised patients with kidney failure and HF. Our findings, drawn from an exploratory analysis, indicate that inpatient midodrine use is associated with increased 6-month mortality. This may reflect deleterious effects from vasoconstriction and/or unmeasured confounders in this vulnerable population. This investigation, utilising TriNetX, was limited by access to deidentified aggregate data, preventing detailed exploration of specifics such as timing, dosage, and indications for midodrine use. Moreover, given its observational nature, cause-effect relationship cannot be established. Our findings indicate an increased mortality associated with midodrine use for hypotension, underscoring the need for further research and consideration of alternative strategies.
米多君是一种经美国食品药品监督管理局（FDA）批准用于治疗直立性低血压的药物，也被超适应证用于治疗包括心力衰竭在内的透析患者低血压。然而，在射血分数降低（HFrEF）和/或右心衰竭患者中，米多君可能有害。目前尚无研究检查米多君在患有心力衰竭的住院肾衰竭患者中的安全性。
在 TriNetX 数据库中检索患有 HFrEF 和/或右心衰竭且出现低血压（收缩压<110mmHg 或平均动脉压<70mmHg）的住院肾衰竭患者。排除需要重症监护或血管加压药的患者后，我们根据米多君的使用情况对队列进行了比较，并对合并症进行了匹配。
分析显示，与未使用米多君的患者相比，使用米多君的患者 6 个月死亡率风险比（RR 1.53，95%可信区间 1.037 至 2.246）和风险比（HR 1.54，95%可信区间 1.022 至 2.317）更高，这表明与死亡率升高相关。
本研究阐明了治疗住院肾衰竭合并心力衰竭患者的复杂性。我们的发现来自于探索性分析，表明住院期间使用米多君与 6 个月死亡率升高相关。这可能反映了血管收缩和/或脆弱人群中未测量的混杂因素的有害影响。本研究利用 TriNetX 进行，受到只能访问去识别的汇总数据的限制，无法详细探索米多君使用的具体情况，如时间、剂量和适应证。此外，由于其观察性，无法建立因果关系。我们的研究结果表明，米多君用于治疗低血压与死亡率升高相关，这强调了需要进一步研究和考虑替代策略。
