Skip Navigation



NDT Advance Access published online on July 27, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh420
© 2004 by European Renal Association - European Dialysis and Transplant Association
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
19/10/2553    most recent
gfh420v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Prakash, S.
Right arrow Articles by House, A. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Prakash, S.
Right arrow Articles by House, A. A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Received May 19, 2004
Accepted June 23, 2004

Original Article

Midodrine appears to be safe and effective for dialysis-induced hypotension: a systematic review

Suma Prakash 1, Amit X. Garg 1, A. Paul Heidenheim 1, Andrew A. House 1*

1 University of Western Ontario and London Health Sciences Centre, Ontario, Canada

* To whom correspondence should be addressed. E-mail: andrew.house{at}lhsc.on.ca.



  Abstract

Background. Dialysis-induced hypotension is an important complication of haemodialysis. Midodrine is an oral {alpha}-1 agonist that has been used in several small studies to prevent intradialytic hypotension (IDH).

Methods. The authors searched MEDLINE, EMBASE, ASN conference proceedings, and references of potentially relevant articles, and contacted industry (Shire Pharmaceuticals) for unpublished data. Observational studies, randomized controlled trials, crossover studies and pre- and post-intervention design studies with ≥5 haemodialysis patients were included. Study outcomes assessed were: hypotensive symptoms, changes in systolic and/or diastolic blood pressure, dry weight and length of stay after treatment. Data were abstracted on: study design, patient characteristics, intradialytic changes in blood pressure, nadir blood pressure and symptom improvement with midodrine. Thirty-seven full text articles were retrieved and nine met the selection criteria, in addition to one unpublished study. Midodrine dosing regimens ranged from 2.5 to 10 mg of midodrine given 15-30 min before dialysis.

Results. Post-dialysis systolic blood pressure was higher by 12.4 mmHg [95% confidence interval (CI) 7.5-17.7] and diastolic pressure was higher by 7.3 mmHg (95% CI 3.7-10.9) during midodrine treatment vs control. Likewise, the nadir systolic blood pressure was higher by 13.3 mmHg (95% CI 8.6-18.0), with a difference in nadir diastolic pressure of 5.9 mmHg (95% CI 2.7-9.1). Six of 10 studies report improvement in symptoms of IDH, and there were no reported serious adverse events ascribed to midodrine.

Conclusions. This systematic review would suggest that midodrine has a role in the therapy of haemodialysis patients experiencing IDH. This conclusion must be viewed with caution, however, given the quality and sample size of the studies included in this review.

Keywords: adrenergic {alpha}-agonists; blood pressure; hypotension; midodrine; renal dialysis; review; systematic.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J. Am. Soc. Nephrol.Home page
B. F. Palmer and W. L. Henrich
Recent Advances in the Prevention and Management of Intradialytic Hypotension
J. Am. Soc. Nephrol., January 1, 2008; 19(1): 8 - 11.
[Abstract] [Full Text] [PDF]

Home page
 J. Pharmacol. Exp. Ther.Home page
M. Tsuda, T. Terada, M. Irie, T. Katsura, A. Niida, K. Tomita, N. Fujii, and K.-i. Inui
Transport Characteristics of a Novel Peptide Transporter 1 Substrate, Antihypotensive Drug Midodrine, and Its Amino Acid Derivatives
J. Pharmacol. Exp. Ther., July 1, 2006; 318(1): 455 - 460.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.