Why the study?
Does fludrocortisone improve post-dialytic blood pressure and interdialytic weight gain in hemodialysis patients with midodrine-resistant perdialytic hypotension?
Does fludrocortisone improve post-dialytic blood pressure and interdialytic weight gain in hemodialysis patients with midodrine-resistant perdialytic hypotension?
Fludrocortisone may be an effective treatment for chronic severe perdialytic hypotension resistant to midodrine, potentially improving post-dialytic blood pressure and reducing interdialytic weight gain.
Fludrocortisone is recommended in patients with orthostatic hypotension and a benefit has been suggested in hemodialysis patients with severe hypokaliemia. We report 2 patients who suffered from chronic severe perdialytic hypotension resistant to midodrine and who were treated in a long-term period with fludrocortisone. A rise of post-dialytic BP was observed with a decrease of the interdialytic weight gain (IWG). We suggest that the IWG decrease is induced by a lessening of the renin angiotensin aldosterone system that could be less stimulated at the end of the dialysis session because of a better-preserved arterial pressure. The decrease of angiotensin could lessen the feeling of thirst.
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Mercadal et al. (2005) studied this question.
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