Abstract: SA-PO1090
Hypoaldosteronism and Bezold-Jarisch Reflex Bradycardia (BJRB): New Causes of Intradialytic Hypotension (IDH) Reversed by Fludrocortisone (FC)
Session Information
- Kidney Replacement Therapy and Care Delivery Innovations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Vega, Melissa Mia, University of Massachusetts Chan Medical School, Springfield, Massachusetts, United States
- Hodgins, Spencer, University of Massachusetts Chan Medical School, Springfield, Massachusetts, United States
- Mulhern, Jeffrey, University of Massachusetts Chan Medical School, Springfield, Massachusetts, United States
- Landry, Daniel L., University of Massachusetts Chan Medical School, Springfield, Massachusetts, United States
- Braden, Gregory Lee, University of Massachusetts Chan Medical School, Springfield, Massachusetts, United States
Background
IDH has complex causes which are incompletely elucidated. BJRB is due to left venrticular mechanoreceptor stimulation leading to decreased sympathetic outflow, bradycardia & vasodilation which is not well recognized as a cause for IDH.
Methods
We studied ESRD patients (pts) with frequent, systolic IDH ≤ 90 mmHg from 2009 – 2018 . 25 pts were found & all were treated with the same dialysis protocol: lower UF rate & Freseniius UF 2, low temp dialysate, sodium modeling & midodrine 5-10 mg pre & mid dialysis. All pts were screened for hypoaladosteroism (HA).11 HA pts had low seum aldos(< 5 ng/ml) mean 2.9 ng/ml & 14 pts had normal aldo (NA) levels mean 35 ng/ml. All pts had normal cosyntropin tests. HA pts were given FC 0.1mg BID.. Pre and Post systolic, diastolic blood pressure (BP), HR, number of IDH events including BJRB & UF were calculated for the 13 treatments pre FC for HA & NA pts & at 1 and 6 months for the HA pts on FC. HA pts continued FC for up to 7 years.
Results
The HA & NA pts matched for age, dialysis vintage & ESRD causes but CHFwas present in 3/11 HA vs 10/14 pts p = 0.02, Diabetes 8/11 HA vs 4/14 NA pts p<0.05, & mean LVEF was 57% in HA vs 32% in NA pts p = 0.03. Table 1 shows the effects of FC in the HA pts after 1 & 6 months. FC significantly improved pre & post systolic BP & heart rate & markedly lessened the episodes of IDH & eliminated BJRB during 6 months of FC BJRB occurred in 8/14 NA pts during 1 month vs 4/11 HA pts before FC p NS.. Deaths within 3 years were 2 in HA vs 9 in NA pts, p<.05. There were no long-term complications of FC.
Conclusion
IDH occurs from hypoaldosteronism and dialysis-induced BJRB & both can be significantly decreased by FC. We believe these results are due to the non-genomic effects of aldo from FC 1) FC can stimulate aldo receptors on arterial walls 2) FC stimulates central sympathetic adrenergic outflow.3) Aldo via FC may lessen the sensitivity of the cardiovagal baroreflex response.Long -term low dose FC in ESRD pts is safe,
Effects of FC in HA
| Pre-FC | 1 mo | 6 mo | |
| Pre SBP | 118 ± 21 | 132 ± 16* | 131 ± 20* |
| Post SBP | 106 ± 15 | 123 ± 18* | 115 ± 17* |
| Pre HR | 74.6 ± 8 | 76 ± 5 | 76 ± 5 |
| Post HR | 74.6 ± 10 | 80 ± 6* | 80 ± 4* |
| IDH Episodes | 2.9 ± 2.3 | 1.0 ± 1* | 1.4 ± 2* |
| BJRB Episodes | 4 | 0* | 0* |
*P < 0.05
Funding
- Clinical Revenue Support