Pharmacologic options available to treat symptomatic intradialytic hypotension.
Treatment of symptomatic intradialytic hypotension (IDH) is a difficult task for the practicing nephrologist. Minimizing patient factors that precipitate IDH as well as dialysis procedure-related components that lower blood pressure are the initial approaches to this problem. However, despite these maneuvers, hypotension often persists in a group of high-risk patients. Pharmacologic interventions are often used to reduce IDH. Unfortunately, many of the available therapies are marginally effective and/or poorly tolerated. A few therapies appear to be efficacious and well tolerated-carnitine, sertraline, and midodrine. This article reviews the various pharmacologic therapies used for IDH and makes recommendations for treatment of this difficult problem.
Perazella
M A
MA
Section of Nephrology, Yale University School of Medicine, New Haven, CT 06520-8029, USA. mark.perazella@yale.edu
D018663:Adrenergic Agents / Q000627:therapeutic use; D001341:Autonomic Nervous System / Q000503:physiopathology; D002110:Caffeine / Q000627:therapeutic use; D002331:Carnitine / Q000627:therapeutic use; D004809:Ephedrine / Q000627:therapeutic use; D005438:Fludrocortisone / Q000627:therapeutic use; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000628:therapy; D008879:Midodrine / Q000627:therapeutic use; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020280:Sertraline / Q000627:therapeutic use
D018663:Adrenergic Agents; D002110:Caffeine; D002331:Carnitine; D004809:Ephedrine; D005438:Fludrocortisone; D008879:Midodrine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline