Reports from the Field: Blood pressure drug prevents kidney trouble
Reports from the Field
Blood pressure drug prevents kidney trouble
A low blood pressure medication, midodrine hydrochloride, also may help kidney disease patients avoid serious side effects of dialysis, according to studies presented at the recent annual meeting of the National Kidney Foundation held in Orlando.
Roughly 250,000 patients with end-stage renal disease undergo dialysis each year. However, after the toxins and excess fluids are removed, the vessels are unable to constrict and return blood to the heart, causing intradialytic hypotension (IDH), or very low blood pressure. The condition affects 20% to 50% of dialysis patients and may cause nausea, vomiting, dizziness, and even life-threatening symptoms such as abnormal heart rhythms and diminished blood supply to the heart and brain. These side effects most often occur in older patients, people with diabetes or heart disease, and people whose bodies cannot automatically compensate for dialysis-induced fluid loss. The side effects cause many patients to stop treatments.
"The complications of IDH take a substantial toll on patients’ health and quality of life, which can force them to discontinue dialysis in the middle of their treatment," notes researcher Mark Perazella, MD, associate professor of medicine and director of the Acute Dialysis Services at Yale School of Medicine in Princeton, NJ. "This can increase the risk of infections and prolonged bleeding, and can even cause premature death. The data from these studies found that midodrine can reduce the symptoms associated with abnormally low blood pressure that can occur during dialysis."
In the two studies presented in Orlando and scheduled for publication in the American Journal of Kidney Diseases, Perazella found that midodrine was effective in patients with IDH who were resistant to other therapies. He also showed that the effects of midodrine were long-lasting. Patients showed significant improvement at one, five, and eight months of therapy. In a comparative study with cool dialysate, a proven therapy for dialysis-associated hypotension, Perazella found that midodrine was associated with fewer side effects, and there were no adverse effects observed.
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