Dialysis patients can avoid serious complications by using medication that normally treats low blood pressure, Yale researcher reports

April 23, 2001

Studies presented today by a Yale researcher at the annual National Kidney Foundation Meeting in Orlando, Florida, show that midodrine hydrochloride, a medication normally used to treat low blood pressure, may also help kidney disease patients avoid some of the serious side effects of dialysis.

"The results of the studies show that midodrine not only effectively blunts the fall in blood pressure during and after dialysis, but it is also well-tolerated and easy to administer," said Mark Perazella, M.D., associate professor of medicine and director of the Acute Dialysis Services at Yale School of Medicine.

About 250,000 patients with end-stage renal disease undergo dialysis, a life-saving procedure that clears toxins and excess fluids from the blood. Between dialysis sessions, the patients accumulate excess fluids, but after the fluids are removed, the vessels are unable to constrict and return blood to the heart, causing intradialytic hypotension (IDH), or very low blood pressure.

This condition affects 20 to 50 percent of dialysis patients and can 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 often cause patients to stop treatments. Perazella said that most medications used to treat IDH in the past have been either modestly effective or poorly tolerated.

IDH occurs most often in dialysis patients who are older, people with diabetes or heart disease, and people whose bodies cannot automatically compensate for dialysis-induced fluid loss by constricting the blood vessels to maintain blood return to the heart. The number of at-risk patients is growing; at least 20 percent of dialysis patients are over 65, and more than half suffer from other illnesses, such as diabetes or high blood pressure.

"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," Perazella said. "This can increase the risk of infections and prolonged bleeding, and can even cause premature death. These data found that midodrine can reduce the symptoms associated with abnormally low blood pressure that can occur during dialysis."

Midodrine works by stimulating nerve endings in the blood vessels, causing them to constrict. As a result, blood pressure is increased. It is used more broadly to treat orthostatic hypotension, a condition in which people experience low blood pressure and other cardiovascular symptoms after standing up from a sitting position, or after standing in a fixed position for a prolonged period of time.

In studies published 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. A significant improvement in patients was noted 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 in any of the studies. Midodrine was also shown to be effective in elderly patients as well as those with diabetes.

Yale University

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.