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Abstract: PO1059

Hypoaldosteronism in Chronic Hemodialysis Patients Causes Intradialytic Hypotension and Is Improved with Fludrocortisone

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hodgins, Spencer, Baystate Health, Springfield, Massachusetts, United States
  • Chapagain, Bikash, Baystate Health, Springfield, Massachusetts, United States
  • Joubert, Jyovani W., Kidney Care and Transplant Services of New England, Springfield, Massachusetts, United States
  • Nathanson, Brian Harris, Optistatim LLC, Longmeadow, Massachusetts, United States
  • Landry, Daniel L., Baystate Health, Springfield, Massachusetts, United States
  • Braden, Gregory Lee, Baystate Health, Springfield, Massachusetts, United States
Background

Intradialytic hypotension (IDH) affects up to 30% of chronic hemodialysis (CHD) pts and hypoaldosteronism (HA) is common in these pts. Aldosterone (aldo) exerts potent non-genomic hypertensive effects via its arterial aldo receptor & enhanced sympathetic nervous system activity.

Methods

We identified 11 consecutive CHD pts with severe IDH & normal cosyntropin stimulation tests that had HA. Mean PRA was 3.3 +/-7.7 ng/mL/hr & serum aldo was 2.9 +/- 1.6 ng/dL. All pts had failed low temperature dialysate, UF and Na modeling and maximum doses of midodrine. We studied pre & post HD SBP & DBP, number of episodes of systolic BP <100 & mean UF volume (Kg) for the 13 dialysis treatments pre fludrocortisone (FC), 1 month post FC & 6 months post FC. FC dose was 0.1 mg BID. The mean pt age was 69 +/- 11 years & dialysis duration was 5.1 +/- 2.3 years.

Results

The mean +/- SD pre & post HD SBP & DBP & the mean number of hypotensive episodes were significantly improved at 1 & 6 months post-FC (Table 1). No changes occurred in UF volume. 4 pts have remained on FC for 2 years or more without side effects and with sustained good results.

Conclusion

Refractory IDH is associated with HA in CHD pts. FC therapy decreases IDH episodes as well as improves pre & post SBP & DBP & can be used safely in CHD pts.