The effect of midodrine hydrochloride on chronic hypotension in patients with diabetes mellitus undergoing hemodialysis therapy

Abstract

Objective: Chronic hypotension is a common complication of hemodialysis in patients with diabetes mellitus. Midodrine hydrochloride is an alpha-1 agonist that effectively corrects in- tradialytic hypotensive attacks. However, the effect of midodrine on chronic hypotension is still unknown in hemodialysis patients. In the present study, we aimed to evaluate the effects of midodrine treatment on chronic hypotension in patients with diabetes mellitus undergoing hemodialysis. Material and Methods: A total of 21 diabetic patients undergoing hemodialysis and had chronic hypotension (systolic blood pressure <100 mmHg before dialysis) were included in the study. Midodrine was given 5 mg p.o. twice a day and 5 mg before every dialysis session to all patients. Blood pressures (pre-hemodialysis systolic, diastolic and mean arterial pressure) were measured. Intra-dialytic hypotension attacks, orthostasis, dizziness, fatigue, blurred vision, dullness, and headache were recorded. Data obtained before midodrine therapy were compared to those collected at the 3rd month of hemodialysis when the patients were under midodrine therapy. Results: Pre-dialysis systolic, diastolic and mean arterial blood pressures, vertigo and syncope attacks were significantly (p< 0.05) improved by midodrine therapy. No significant difference was seen in mean ultra-filtration volume per hemodialysis session and number of intra-dialytic hypotensive attacks according to baseline values over the course of study (p>0.05). Conclusion: Midodrine appears to be an effective and safe treatment option in diabetic hemodialysis patients with symptomatic chronic hypotension, but it has no effect on intra-dialytic hypotensive attacks. © 2011 by Türkiye Klinikleri.