BACKGROUND: The effects of midodrine on chronic hypotension in hemodialysis (HD) patients have not been well investigated. METHODS: We evaluated midodrine's effect on autonomic function and hemodynamics in 12 HD patients who had chronic systolic blood pressure less than 100 mm Hg. Midodrine (5.0 mg) twice a day was given for 4 weeks. Another 12 age- and sex-matched HD patients with normotension were selected as a control group. Autonomic function tests included the heart-rate responses to the Valsalva maneuver and 30:15 ratio as well as supine and standing blood pressure (BP) and sustained hand-grip test. Hemodynamic changes included 24-hour blood pressure, cardiac output, total peripheral resistance (TPR), and plasma renin and aldosterone concentrations. RESULTS: Compared with the control subjects, HD patients with chronic hypotension had more severe autonomic dysfunction and significantly lower TPR. After 4 weeks of midodrine therapy, sympathetic function (orthostatic and hand-grip tests) improved in conjunction with significant increases in mean arterial pressure (MAP) (79.5 +/- 4.9 to 85.0 +/- 5.1 mm Hg, P < 0.05) and TPR (768 +/- 37 versus 1097 +/- 72 dyne/sec/cm-5, P < 0.01) despite no significant change in Valsalva ratio, 30:15 ratio, and cardiac output. MAP changes were positively correlated with TPR changes (r = 0.82, P < 0.001). Supine plasma renin activity was significantly increased. In addition, MAP during HD was also significantly increased during midodrine therapy. CONCLUSIONS: Midodrine improves chronic hypotension in HD patients by modulating autonomic function and its direct effects on peripheral vessels.
BACKGROUND: The effects of midodrine on chronic hypotension in hemodialysis (HD) patients have not been well investigated. METHODS: We evaluated midodrine's effect on autonomic function and hemodynamics in 12 HDpatients who had chronic systolic blood pressure less than 100 mm Hg. Midodrine (5.0 mg) twice a day was given for 4 weeks. Another 12 age- and sex-matched HDpatients with normotension were selected as a control group. Autonomic function tests included the heart-rate responses to the Valsalva maneuver and 30:15 ratio as well as supine and standing blood pressure (BP) and sustained hand-grip test. Hemodynamic changes included 24-hour blood pressure, cardiac output, total peripheral resistance (TPR), and plasma renin and aldosterone concentrations. RESULTS: Compared with the control subjects, HDpatients with chronic hypotension had more severe autonomic dysfunction and significantly lower TPR. After 4 weeks of midodrine therapy, sympathetic function (orthostatic and hand-grip tests) improved in conjunction with significant increases in mean arterial pressure (MAP) (79.5 +/- 4.9 to 85.0 +/- 5.1 mm Hg, P < 0.05) and TPR (768 +/- 37 versus 1097 +/- 72 dyne/sec/cm-5, P < 0.01) despite no significant change in Valsalva ratio, 30:15 ratio, and cardiac output. MAP changes were positively correlated with TPR changes (r = 0.82, P < 0.001). Supine plasma renin activity was significantly increased. In addition, MAP during HD was also significantly increased during midodrine therapy. CONCLUSIONS:Midodrine improves chronic hypotension in HDpatients by modulating autonomic function and its direct effects on peripheral vessels.
Authors: Tarek Alhamad; Daniel C Brennan; Zaid Brifkani; Huiling Xiao; Mark A Schnitzler; Vikas R Dharnidharka; David Axelrod; Dorry L Segev; Krista L Lentine Journal: Transplantation Date: 2016-05 Impact factor: 4.939
Authors: Pranab M Barman; Lindsay Y King; Carl L Berg; Alice Parish; Donna Niedzwiecki; Andrew S Barbas; Lisa McElroy; Yuval A Patel Journal: Transplant Direct Date: 2020-12-15