title: Pretransplant Midodrine Use: A Newly Identified Risk Marker for Complications After Kidney Transplantation.
abstract: Midodrine is prescribed to prevent symptomatic hypotension and decrease complications associated with hypotension during dialysis. We hypothesized that midodrine use before kidney transplantation may be a novel marker for posttransplant risk.
  
  
  
  We analyzed integrated national US transplant registry, pharmacy records, and Medicare claims data for 16 308 kidney transplant recipients transplanted 2006 to 2008, of whom 308 (1.9%) had filled midodrine prescriptions in the year before transplantation. Delayed graft function (DGF), graft failure, and patient death were ascertained from the registry. Posttransplant cardiovascular complications were identified using diagnosis codes on Medicare billing claims. Adjusted associations of pretransplant midodrine use with complications at 3 and 12 months posttransplant were quantified by multivariate Cox or logistic regression, including propensity for midodrine exposure.
  
  
  
  At 3 months, patients who used midodrine pretransplant had significantly (P < 0.05) higher rates of DGF, 32% versus 19%; hypotension, 14% versus 4%; acute myocardial infarction, 4% versus 2%; cardiac arrest, 2% versus 0.9%, graft failure, 5% versus 2%; and death, 4% versus 1% than nonusers. After multivariate adjustment including recipient and donor factors, as well as for the propensity of midodrine exposure, pretransplant midodrine use was independently associated with risks of DGF (adjusted odds ratio, 1.78; 95% confidence interval [CI], 1.36-2.32), and 3 month death-censored graft failure (adjusted hazard ratio, 2.0; 95% CI, 1.18-3.39), and death (adjusted hazard ratio, 3.49; 95% CI, 1.95-6.24). Patterns were similar at 12 months.
  
  
  
  Although associations may in part reflect underlying conditions, the need for midodrine before kidney transplantation is a risk marker for complications including DGF, graft failure, and death.
authors.affiliation: 1 Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 2 Transplant Epidemiology Research Collaboration (TERC), Institute of Public Health, Washington University School of Medicine, St. Louis, MO. 3 Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO. 4 Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO. 5 Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH. 6 Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD. 7 Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: Tarek
authors.initials: T
authors.lastname: Alhamad
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Zaid
authors.initials: Z
authors.lastname: Brifkani
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: Vikas R
authors.initials: VR
authors.lastname: Dharnidharka
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D005819:Genetic Markers; D006085:Graft Survival; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D008879:Midodrine / Q000008:administration & dosage*; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D005819:Genetic Markers; D014662:Vasoconstrictor Agents; D008879:Midodrine