Abstract: SA-PO886
Midodrine in the Context of Intradialytic Hypotension: Association with Outcomes
Session Information
- Dialysis: Cardiovascular, BP, Volume
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States
- Cohen, Dena E., DaVita Clinical Research, Minneapolis, Minnesota, United States
- Marlowe, Gilbert, DaVita Clinical Research, Minneapolis, Minnesota, United States
- Van Wyck, David B., DaVita Institute for Patient Safety, Denver, Colorado, United States
Background
Intradialytic hypotension (IDH) is a frequent complication of hemodialysis, and is associated with significant morbidity and mortality. Off-label use of the alpha-1 andrenergic receptor agonist midodrine to reduce the frequency and severity of IDH is common. Small-scale clinical trial data support this practice; however, limited data exist with regard to real-world efficacy.
Methods
In this retrospective, observational study, clinical and hemodynamic outcomes were compared among patients who began midodrine (N=1046) and controls (N=2037) to whom they were matched on the basis of baseline pre-dialysis blood pressure, nadir intra-dialytic blood pressure and the frequency of intradialytic hypotension, all of whom were adults receiving in-center hemodialysis in the United States (July 2015-September 2016). All study data were derived from deidentified patient electronic health records. Outcomes were considered from the month following initiation of midodrine (or corresponding month for controls) until censoring for loss to follow-up or study end (30 September 2016). Outcomes were compared using adjusted Poisson or linear mixed models following intention-to-treat principles.
Results
Compared to non-use, midodrine use was associated with higher rates of death (adjusted incidence rate ratio 1.37, 95% confidence interval 1.15- 1.62), all-cause hospitalization (1.31, 1.19-1.43) and cardiovascular hospitalization (1.41, 1.17-1.71). With respect to hemodynamic outcomes, midodrine use tended to be associated with lower pre-dialysis systolic blood pressure (SBP), lower nadir SBP, greater fall in SBP during dialysis, and a greater proportion of treatments affected by IDH.
Conclusion
Although residual confounding may have influenced results, the observed associations are not consistent with a potent protective effect of midodrine with respect to either clinical or hemodynamic outcomes.
Funding
- Commercial Support – This was a research project conducted by the DaVita Institute for Patient Safety and supported by DaVita Kidney Care