Midodrine is effective and safe therapy for intradialytic hypotension over 8 months of follow-up.
Midodrine is effective and safe therapy for intradialytic hypotension over 8 months of follow-up.
复制标题
米多君是治疗透析中低血压超过 8 个月随访的有效且安全的疗法。
作者：
D. Cruz;R. Mahnensmith;H. Brickel;M. Perazella
透析性低血压(IDH)是血液透析中常见且令人沮丧的并发症。某些终末期肾病(ESRD)患者反复表现出这种致残状态。患者特有的因素(自主神经功能不全、心脏病)和与透析治疗相关的因素(超滤、核心体温升高)都被认为具有重要的致病作用。到目前为止，大多数治疗干预要么不成功，要么耐受性差。然而，最近的研究表明，米多君是一种口服外周α-1肾上腺素能激动剂，在短期内是治疗症状性IDH的一种有效且安全的治疗方法。我们报告了13例血液透析(HD)患者在透析前使用米多君治疗IDH的5至8个月的经验。13例复发症状性IDH患者(男8例，女5例，平均年龄63.9岁)在每次透析前30分钟口服米多君10 mg。在每次HD治疗中记录血压(HD前、透析中最低[ID]BP、HD后BP)和体重。在米多君治疗前的10次HD疗程(基线)与米多君治疗1、5和8个月期间的值(各10次HD疗程)进行比较。数据分析采用单因素方差分析进行重复测量和配对t检验，每个患者作为自己的对照。分别监测5个月(13例)和8个月(8例)。所有透析中最低血压、HD后SBP和MAP在米多君治疗后均有显著改善(p<；0.05)。这一效果在所有随访期内都保持不变。平均白蛋白、红细胞压积、Kt/V、钙和钠在基线和所有随访期间均无显著差异。在研究过程中，每个HD疗程的平均超滤量与基线没有显著差异。低血压症状的主观改善也被注意到。重要的是，在所有的随访期中，米多君都没有出现不良反应。米多君对患有症状性IDH的HD患者似乎是一种有效和安全的治疗方法，如果长期使用，仍然是有益的。
Intradialytic hypotension (IDH) is a common and frustrating complication of hemodialysis. Certain end stage renal disease (ESRD) patients recurrently manifest this disabling condition. Both patient-specific factors (autonomic insufficiency, cardiac disease) and dialysis treatment-related factors (ultrafiltration, increased core body temperature) are thought to have significant causative roles. Most therapeutic interventions to date have been either unsuccessful or poorly tolerated. However, recent studies have shown that midodrine, an oral peripheral alpha-1 adrenergic agonist, is an effective and safe therapy for symptomatic IDH in the short-term. We report our experience with the predialysis use of midodrine for IDH in 13 hemodialysis (HD) patients over a 5 to 8 month period. Thirteen patients (8 male, 5 female, mean age 63.9 yrs) with recurrent symptomatic IDH were given midodrine 10 mg orally 30 min before each HD session. Blood pressures (pre-HD BP, lowest intradialytic [ID] BP, post-HD BP) and body weights were tracked for each HD treatment. Values for 10 HD sessions prior to midodrine therapy (Baseline) were compared to values (10 HD sessions each) during the 1st, 5th and 8th month of midodrine therapy. Data were analyzed using ANOVA for repeated measures and paired t-tests, with each patient serving as his/her own control. Patients were monitored for 5 months (n = 13) and 8 months (n = 8), respectively. All lowest intradialytic BPs, post-HD SBPs, and MAPs were significantly improved (p <0.05) on midodrine therapy. This effect was maintained during all periods of follow-up. There was no significant difference in mean albumin, hematocrit, Kt/V, calcium, and sodium between baseline and all periods of follow-up. Mean ultrafiltration volume per HD session was not significantly different than baseline over the course of study. A subjective improvement in hypotensive symptoms was also noted. Importantly, there were no adverse reactions to midodrine in all periods of follow-up. Midodrine appears to be an effective and safe treatment for HD patients with symptomatic IDH, and remains beneficial when used for an extended period of time.