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International Journal of Clinical and Experimental Medicine Research

ISSN Online: 2575-7970 Downloads: 308082 Total View: 2951628
Frequency: quarterly ISSN Print: 2575-7989 CODEN: IJCEMH
Email: ijcemr@hillpublisher.com
Article Open Access http://dx.doi.org/10.26855/ijcemr.2021.07.024

Fludrocortisone for Treatment of Intradialytic Hypotension: Case Report and Review of Literature

Nasser Mikhail

Endocrinology Division, Department of Medicine, Olive-View-UCLA Medical School, David-Geffen UCLA School of Medicine, Sylmar, CA, USA.

*Corresponding author: Nasser Mikhail

Published: July 27,2021

Abstract

Background: Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD). Pharmacologic treatment options are limited in terms of number and efficacy. Objective: To report a case of IDH that responded to fludrocortisone. Similar cases and pertinent literature were reviewed. Methods: Pubmed research of English literature up to June 16, 2021. Search terms included, hemodialysis, hypotension, intradialytic hypotension, midodrine, fludrocortisone, droxidopa, safety, efficacy. Retrospective studies, case report and series, Cochrane reviews, randomized trials are reviewed. Results: Midodrine and droxidopa are approved by the Federal Drug Administration (FDA) for treatment of orthostatic hypotension, but not for IDH. No randomized trials are available to evaluate midodrine for IDH. One large retrospective study suggests that midodrine use for treatment of IDH may be associated with increase death and hospitalization. Results of a single randomized phase 2 trial suggest that droxidopa may not be effective in IDH. The author reports a 63-year-old patient with IDH who failed midodrine but responded to the addition of fludrocortisone. Review of literature revealed 3 other similar cases, No short-term adverse effects of fludrocortisone were reported in any of these 4 cases. Conclusions: Pharmacological options available for treatment of IDH are limited and inadequately studied. Fludrocortisone appears a promising agent to prevent IDH in patients failing midodrine. Randomized trials are needed to compare efficacy and safety of midodrine and fludrocortisone and their combination for management of IDH.

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How to cite this paper

Fludrocortisone for Treatment of Intradialytic Hypotension: Case Report and Review of Literature

How to cite this paper: Nasser Mikhail. (2021) Fludrocortisone for Treatment of Intradialytic Hypotension: Case Report and Review of LiteratureInternational Journal of Clinical and Experimental Medicine Research5(3), 383-386.

DOI: http://dx.doi.org/10.26855/ijcemr.2021.07.024