Cruz D N, Mahnensmith R L, Brickel H M, Perazella M A
Department of Medicine, Yale University School of Medicine, New Haven, CT 06520-8029, USA.
Clin Nephrol. 1998 Aug;50(2):101-7.
Intradialytic hypotension (IDH) is a common and frustrating complication of hemodialysis. Certain end stage renal disease (ESRD) patients recurrently manifest this disabling condition. Both patient-specific factors (autonomic insufficiency, cardiac disease) and dialysis treatment-related factors (ultrafiltration, increased core body temperature) are thought to have significant causative roles. Most therapeutic interventions to date have been either unsuccessful or poorly tolerated. However, recent studies have shown that midodrine, an oral peripheral alpha-1 adrenergic agonist, is an effective and safe therapy for symptomatic IDH in the short-term. We report our experience with the predialysis use of midodrine for IDH in 13 hemodialysis (HD) patients over a 5 to 8 month period. Thirteen patients (8 male, 5 female, mean age 63.9 yrs) with recurrent symptomatic IDH were given midodrine 10 mg orally 30 min before each HD session. Blood pressures (pre-HD BP, lowest intradialytic [ID] BP, post-HD BP) and body weights were tracked for each HD treatment. Values for 10 HD sessions prior to midodrine therapy (Baseline) were compared to values (10 HD sessions each) during the 1st, 5th and 8th month of midodrine therapy. Data were analyzed using ANOVA for repeated measures and paired t-tests, with each patient serving as his/her own control. Patients were monitored for 5 months (n = 13) and 8 months (n = 8), respectively. All lowest intradialytic BPs, post-HD SBPs, and MAPs were significantly improved (p <0.05) on midodrine therapy. This effect was maintained during all periods of follow-up. There was no significant difference in mean albumin, hematocrit, Kt/V, calcium, and sodium between baseline and all periods of follow-up. Mean ultrafiltration volume per HD session was not significantly different than baseline over the course of study. A subjective improvement in hypotensive symptoms was also noted. Importantly, there were no adverse reactions to midodrine in all periods of follow-up. Midodrine appears to be an effective and safe treatment for HD patients with symptomatic IDH, and remains beneficial when used for an extended period of time.
透析中低血压（IDH）是血液透析常见且令人困扰的并发症。某些终末期肾病（ESRD）患者反复出现这种致残性病症。患者特异性因素（自主神经功能不全、心脏病）和透析治疗相关因素（超滤、核心体温升高）都被认为具有重要的致病作用。迄今为止，大多数治疗干预措施要么不成功，要么耐受性差。然而，最近的研究表明，米多君，一种口服外周α-1肾上腺素能激动剂，在短期内是治疗有症状IDH的有效且安全的疗法。我们报告了在5至8个月期间对13例血液透析（HD）患者在透析前使用米多君治疗IDH的经验。13例反复出现有症状IDH的患者（8例男性，5例女性，平均年龄63.9岁）在每次HD治疗前30分钟口服10毫克米多君。每次HD治疗时记录血压（HD前血压、透析中最低[ID]血压、HD后血压）和体重。将米多君治疗前10次HD治疗（基线）的值与米多君治疗第1、5和8个月期间的值（各10次HD治疗）进行比较。使用重复测量方差分析和配对t检验分析数据，每位患者作为自身对照。患者分别接受了5个月（n = 13）和8个月（n = 8）的监测。在米多君治疗期间，所有透析中最低血压、HD后收缩压和平均动脉压均有显著改善（p <0.05）。在所有随访期间这种效果均得以维持。基线与所有随访期间的平均白蛋白、血细胞比容、Kt/V、钙和钠之间无显著差异。在研究过程中，每次HD治疗的平均超滤量与基线无显著差异。还注意到低血压症状有主观改善。重要的是，在所有随访期间均未出现米多君的不良反应。米多君似乎是治疗有症状IDH的HD患者的有效且安全的疗法，并且长期使用仍然有益。
