A Study on Effect of Midodrine in Prevention of Intradialytic Hypotension in A Tertiary Referral Hospital

Abstract

Background: Hemodialysis patients often encounter a common and frustrating complication of intradialytic hypotension (IDH). IDH is associated with higher morbidity, limits fluid removal during dialysis and increases the need for nursing interventions as well as mortality. Patient’s specific factors (autonomic insufficiency, cardiac disease) as well as dialysis- treatment related factors (ultrafiltration, increased core body temperature) are significant causative association. Most therapeutic interventions have been either unsuccessful or poorly tolerated. Midodrine, an oral selective peripherally acting α-1 adrenergic agonist, is commonly used to prevent IDH.

Objective: To evaluate the effectiveness of using midodrine in patients receiving hemodialysis concerning the incidence of IDH.

Methodology: This was an institution based prospective study which was carried out among the patients admitted in the Department of Nephrology, Gauhati medical college and hospital, Guwahati, Assam  with end-stage-renal failure on Maintaining hemodialysis with IDH. A total of 28 patients (19 males, 9 females) with recurrent symptomatic IDH were given midodrine 5mg orally 30 minutes before each HD session. Blood pressures (pre- HD BP, lowest intradialytic BP and post HD BP) were measured. Values for 2 HD sessions prior to midodrine therapy (baseline) were compared to the values 2 HD post midodrine therapy.

Results: From a total of 28 patients included in the study 42.9% have not developed IDH post midodrine therapy whereas 57.1% of the study population had an IDH that required additional interventions to restore the SBP and MAP. A subjective improvement seen among the patients who did not develop IDH following midodrine administration. There were no adverse reactions to midodrine seen among the study populations. Conclusion: This study shows that a considerable proportion of patients receiving midodrine did not develop IDH. Midodrine appears to be effective and safe for HD patients with symptomatic IDH. However a long-term follow-up study with larger number of patients in comparison to the control group would be useful to evaluate the magnitude of efficacy of midodrine in hemodialysis patients with high risk for IDH.