ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO358

The Safety and Efficacy of Clonidine in Hemodialysis Patients: A Systematic Review and Meta-Analysis

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Derk, Gwendolyn, University of Illinois, Urbana, Illinois, United States
  • Pai, Amy Barton, University of Michigan, Ann Arbor, Michigan, United States
  • An, Ruopeng, Univresity of Illinois at Urbana-Champaign, Champaign, Illinois, United States
  • Wilund, Ken, University of Illinois, Urbana, Illinois, United States

Group or Team Name

  • Renal and Cardiovascular Disease Research Laboratory UIUC
Background

The United States Renal Data System data shows that 20% of hemodialysis (HD) patients are prescribed clonidine to treat hypertension. Clonidine is a centrally acting alpha 2 adrenergic agonist, and the balance between potential efficacy and its known adverse effects is unknown in HD patients. This study systematically reviewed existing evidence and performed a meta-analysis on the safety and efficacy of clonidine in HD patients.

Methods

Keyword and reference search was conducted through February 2018 in PubMed Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov databases. Inclusion criteria were - study design: randomized controlled trials, cohort studies, prospective studies, retrospective studies or case series; subjects: adult HD patients; main outcome: blood pressure and safety; language: English; and article type: peer-reviewed publications.

Results

Eight studies met the inclusion criteria, including two prospective pre-post studies, one double-blind controlled trial, one single blinded placebo-controlled trial, one crossover open-label clinical trial, one retrospective analysis, and two case report series. Study durations ranged from 2 to 8 weeks, with a total sample size of 23. Risk of bias was high for all included studies. Significant side effects and adverse events include hypotension, lightheadedness, drowsiness, dry mouth, and rebound hypertension for oral clonidine, as well as contact dermatitis for patch application. Meta-analysis (random effect model) found short-term clonidine use to be associated with significant improvement in systolic blood pressure (pooled effect: -12.985, 95% CI[7.878, 18.092], p<0.001) while changes in diastolic blood pressure were not statistically significant (-11.119, 95% CI[-22.725, 0.487], p=0.060). There is currently no data on the long-term efficacy of clonidine in dialysis patients.

Conclusion

Despite its widespread use, there is no evidence supporting the long-term use of clonidine in the HD population and significant safety concerns. There is low-quality evidence demonstrating the efficacy of clonidine in lowering blood pressure in HD patients in the short term. Clonidine is poorly tolerated and has a potentially dangerous adverse effect profile. Future studies on anti-hypertensives with known cardiovascular benefits should be studied more rigorously in the HD population.