Effect of sertraline hydrochloride on cardiac autonomic dysfunction in patients with hemodialysis-induced hypotension.
OBJECTIVE
It was previously shown that sertraline hydrochloride treatment improved hemodynamic parameters of patients with dialysis induced hypotension (DIH). The aim of this study was to examine the effect of sertraline on the autonomic functions of patients with DIH.


METHODS
Ten patients with DIH, 10 hemodialysis patients without DIH and 10 healthy control subjects were included into the study. All of the patients were treated with sertraline 50 mg per day for 4 weeks. Pre-treatment and post-treatment heart rate variability (HRV) in supine and tilt position was evaluated. In order to evaluate the autonomic response to tilt position, gap values were calculated by subtracting the HRV in supine position from the HRV in tilt position.


RESULTS
Analysis of the HRV response to tilt, demonstrated a paradoxical reduction in the indices of sympathetic modulation and sympathovagal balance in the patients with DIH while there was an increase in normalized powers of low frequency components (LFNU) and low frequency to high frequency components ratio (LFP/HFP) in the patients without DIH and control group. The number of therapeutic interventions for restoration of DIH decreased significantly in the sertraline period (p < 0.001). The gap values of the patients with DIH in LFNU (sympathetic modulation) (p < 0.05) and LFP/HFP (sympathovagal balance) increased in the sertraline period (p < 0.01). The decrease in gap value of normalized powers of high frequency components (parasympathetic modulation) was pronounced in the sertraline period in the patients with DIH (p < 0.05).


CONCLUSIONS
The preventive effect of sertraline on DIH might be related to the improvement of regulation of autonomic response to hypovolemia.
Yalcin
Ahmet Ugur
AU
Department of Nephrology, Osmangazi University Medical School, Eskisehir, Turkey. auyalcin@ogu.edu.tr
Kudaiberdieva
Gulmira
G
Sahin
Garip
G
Gorenek
Bulent
B
Akcar
Nevbahar
N
Kuskus
Serhat
S
Bayrak
Figen
F
Timuralp
Bilgin
B
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000188:drug therapy* / Q000503:physiopathology; D016022:Case-Control Studies; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000294:innervation* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D020280:Sertraline / Q000627:therapeutic use*; D016683:Supine Position; D018667:Tilt-Table Test
D020280:Sertraline