Sertraline hydrochloride treatment for patients with hemodialysis hypotension.
BACKGROUND
Recently some pathogenetic parallels have been drawn between dialysis-induced hypotension and disorders characterized by hemodynamic instability due to autonomic dysfunction, such as neurocardiogenic syncope and idiopathic orthostatic hypotension. Several studies have shown that central serotonergic pathways participate in the abnormal response, and selective serotonin reuptake inhibitors improve the symptoms of patients with neurocardiogenic syncope or idiopathic orthostatic hypotension. In order to evaluate the effectiveness of sertraline on dialysis-induced hypotension a prospective study was designed.


METHODS
The data of 9 patients from a 4-week pre-sertraline period were compared with the data of a 4-week sertraline (100 mg daily) period. The therapeutic effect of sertraline requires 4 weeks. Therefore the sertraline period was begun 4 weeks after starting the drug.


RESULTS
Post-hemodialysis weights and ultrafiltration volumes were similar in the pre-sertraline and sertraline periods. There were also no changes in hematocrit and serum albumin. Both systolic and diastolic blood pressure before dialysis remained unchanged during sertraline treatment. The nadir systolic blood pressure and systolic blood pressure after dialysis increased significantly in the sertraline period. The nadir diastolic pressure was also increased significantly but the increase in post-dialysis diastolic blood pressure did not reach statistical significance. The necessity of therapeutic interventions per dialysis session decreased significantly in the sertraline period compared with pre-sertraline period.


CONCLUSIONS
This pilot study has shown that sertraline has the potential to be a safe and effective therapy for dialysis hypotension. Long-term clinical and pathophysiological studies are currently in progress.
Yalcin
Ahmet Uğur
AU
Department of Nephrology, Osmangazi University School of Medicine, Eskisehir, Turkey. auyalcin@ogu.edu.tr
Sahin
Garip
G
Erol
Mehmet
M
Bal
Cengiz
C
D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D020280:Sertraline / Q000008:administration & dosage* / Q000494:pharmacology
D020280:Sertraline