title: A randomized, placebo-controlled, phase 2 study of the efficacy and safety of droxidopa in patients with intradialytic hypotension.
abstract: BACKGROUND
  Intradialytic hypotension (IDH) is the most common complication of hemodialysis (HD), and it plays a significant role in the morbidity and mortality associated with maintenance HD.
  
  
  METHODS
  This was a placebo-controlled, parallel-group study evaluating efficacy and safety of droxidopa in improving intradialytic blood pressure (BP) responses in 85 adults with end-stage renal disease (ESRD) and prone to IDH. Following screening and baseline periods, patients received 400 mg or 600 mg droxidopa, or placebo, orally 1 hour before HD for 4 weeks. Primary outcome endpoint was the change between baseline and last 2 treatment weeks in average mean arterial pressure (MAP) during HD. Also assessed were changes from baseline in systolic BP (SBP) and diastolic BP (DBP) during and after HD; number of hypotension-induced interventions and symptoms; and adverse events.
  
  
  RESULTS
  Increase in droxidopa intra-HD MAP were not significantly different from placebo, although droxidopa groups showed significant improvements in mean SBP after HD of +4.8 ± 11.6 mm Hg (600-mg) and +3.4 ± 13.1 (400-mg) compared with -4.4 ± 17.9 mm Hg in placebo, and the drop seen in mean nadir SBP pre- to intra-HD was also reduced. Changes in mean DBP pre- and post-HD, changes in mean nadir SBP post-HD, or intra-HD SBP were not significant over the treatment period. HD terminations decreased 5-fold in the 600-mg group and 2-fold in the 400-mg group, whereas the number of discontinuations stayed unchanged in the placebo group. Overall, treatment with 600-mg or 400-mg droxidopa was well tolerated in this population.
  
  
  CONCLUSIONS
  These data suggest that droxidopa may have a role in reducing IDH complications in patients with ESRD on chronic HD.
authors.affiliation: Eastern Nephrology CMTG , Greenville, NC , USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Vannorsdall
authors.forename: Srinivas
authors.initials: S
authors.lastname: Hariachar
authors.forename: L Arthur
authors.initials: LA
authors.lastname: Hewitt
mesh_terms: D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents; D004311:Double-Blind Method; D015103:Droxidopa / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D000978:Antiparkinson Agents; D015103:Droxidopa
keywords: Hemodialysis; droxidopa; end-stage renal disease; intradialytic hypotension; treatment