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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


  • 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

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.


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.


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.


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.