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Kidney Week

Abstract: SA-OR48

Role of Midodrine in Prevention of Intradialytic Hypotension: A Randomized Cross-Over Controlled Trial

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Krisanapan, Pajaree, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
  • Techakajornkeart, Rattiporn, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
  • Kunawathanakul, Sithichai, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
  • Tantiyavarong, Pichaya, Thammasat University Faculty of Medicine, Khlong Nueng, Pathum Thani, Thailand
  • Eiamsitrakoon, Thanee, Thammasat University, Bangkok, Thailand
  • Traitanon, Opas, Thammasat University Faculty of Medicine, Khlong Nueng, Pathum Thani, Thailand
  • Pattharanitima, Pattharawin, Thammasat University Faculty of Medicine, Khlong Nueng, Pathum Thani, Thailand
Background

Intradialytic hypotension (IDH) is one of the most common complications in hemodialysis (HD) patients. It is associated with reduced quality of life as well as an increased risk of myocardial infarction and mortality. Although midodrine, an α-1 adrenergic receptor agonist, has been proposed as a potential benefit in the prevention of IDH and has demonstrated efficacy in some studies, its long-term use with normal dialysate calcium has not yet been established.

Methods

This cross-over, placebo-controlled trial recruited adult patients who received thrice-weekly HD and had frequent IDH during the past 3 months. Participants were randomized to receive either oral 10-mg midodrine or placebo pills. The administration of the drugs took place 30 minutes prior to each dialysis session over a duration of 2 months (24 sessions) in each phase, with a one-week washout period between phases. All patients were prescribed a dialysate calcium concentration of 2.5 mEq/L. The trial protocol for this study was registered at thaiclinicaltrials.org (TCTR20211007003).

Results

In the midodrine treatment group, the incidence rate of IDH was significantly lower compared to the placebo group (8.5 vs. 16.0 events per 100 HD sessions, p = 0.004). Furthermore, the midodrine group demonstrated significantly reduced incidence rates of dizziness (7.7 vs 16.2 events per 100 HD sessions, p < 0.001) and headache (0 vs 1.3 events per 100 HD sessions, p = 0.04). However, there were no significant differences observed between the midodrine and placebo groups in terms of nadir systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR). Regarding safety, there were no significant differences in the incidence of adverse events between the two treatment groups.

Conclusion

Midodrine demonstrates safety and efficacy as a prophylactic intervention for IDH while also effectively mitigating symptoms of dizziness and headache in patients undergoing hemodialysis with a normal dialysate calcium concentration.

Funding

  • Commercial Support – Cosma trading Ltd.