Abstract: TH-PO0504
Midodrine Use in Patients with ESKD on Hemodialysis (HD)
Session Information
- Dialysis: Novel Therapeutics and Medication Management
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Hoenemeyer, John, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Gandhi, Ronit, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Samson, Kaeli, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Birch, Nathan C., VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, United States
- Tendulkar, Ketki K., University of Nebraska Medical Center, Omaha, Nebraska, United States
Background
Midodrine is frequently used to manage intradialytic hypotension. Its role near the end of life remains unclear. This study examines patterns of midodrine use, hospice enrollment, and healthcare utilization in a cohort of deceased patients on hemodialysis (HD).
Methods
This was a retrospective analysis of de-identified data collected from deceased ESKD patients treated with midodrine. The following clinical data were collected: Age, gender, comorbid conditions (diabetes mellitus, hypertension, coronary artery disease, peripheral vascular disease, congestive heart failure), and duration of midodrine use. Descriptive statistics were generated and comparisons of midodrine duration were made between subgroups of categorical variables of interest, with medians and interquartile ranges reported alongside Wilcoxon Rank Sum p-values. Relationships between continuous variables of interest (i.e., midodrine dose and time from HD start to midodrine start) and duration of midodrine use were visualized via scatterplots and assessed using Pearson correlation coefficients.
Results
This analysis examined 37 deceased hemodialysis patients who were prescribed midodrine. The average age was 73 years, and the median time on dialysis was approximately 3 years (1,153 days). This cohort had a high burden of comorbidities, including diabetes (70.3%), hypertension (86.5%), and congestive heart failure (73%). The median duration of midodrine use was 179 days (range: 0-2745 days). There were no statistically significant associations between midodrine dose, timing of initiation, and presence of comorbidities.
Conclusion
The median time from initiation of midodrine to death was 179 days (about 6 months), suggesting that midodrine initiation may serve as a practical, underrecognized marker of functional and physiological decline in patients on hemodialysis. Prospective studies are needed to confirm this. Early identification of decline may support timelier palliative care engagement.