Hemodialysis in hypotensive heart failure using midodrine.
BACKGROUND
Dialysis in patients with severe congestive heart failure and low blood pressure is difficult even in a hospital setting. We retrospectively recorded the effects and usefulness of an alpha (1) agonist in an outpatient dialysis unit in 5 patients with end-stage renal disease with symptomatic heart failure and low blood pressure. To provide outpatient dialysis, they were given midodrine before and during their dialysis sessions.


METHODS
The volume of fluid removed, the lowest blood pressure, and postdialysis blood pressure measurements were recorded during a 3- to 4-week period just before initiating therapy (control period) and were compared with the measurements while using midodrine (treatment period). The blood pressures were expressed as the average of the mean arterial pressures (MAP).


RESULTS
All patients had an increase in the lowest MAP during dialysis and in the postdialysis MAP. Each was significant at P = 0.03. Fluid removal was significant at P = 0.04. All the patients improved in their symptoms of orthopnea and shortness of breath.


CONCLUSIONS
Outpatient dialysis is possible and relieves the symptoms of congestive heart failure in patients with poor heart function, low blood pressure, and advanced age when midodrine is given immediately before and during the procedure.
Bergman
Suzanne M
SM
Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama 35294-007, USA. sbergman@uab.edu
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies
D000316:Adrenergic alpha-Agonists; D008879:Midodrine