Abstract: PUB128
Midodrine-Induced Ischemic Vascular Injury: A Case Report in Patients on Hemodialysis
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Vo, Hillary, Dallas Renal Group, Dallas, Texas, United States
- Khan, Shehpar, Dallas Renal Group, Dallas, Texas, United States
- Nangia, Samir, Dallas Renal Group, Dallas, Texas, United States
Introduction
Midodrine is an alpha-agonist that increases blood pressure by inducing vasoconstriction. It is widely prescribed due to its efficacy in managing hemodialysis-associated hypotension in ESRD patients. Midodrine is generally well-tolerated by most patients. However, despite its rarity, we present a case highlighting an adverse effect of midodrine.
Case Description
We present the case of a 68-year-old male with ESRD on hemodialysis, with a history of type 2 diabetes-associated nephropathy, CAD, and CHF with EF 20-25%. The patient was initiated on Midodrine 10mg three times a day for hypotension. He presented after 3 weeks with numbness, discoloration of digits, and gangrenous lesions. He denied any specific injury or use of calcium-based phosphorus binders. ABI of the left lower extremity was as low as 0.5. ANCA and ANA tests were negative, and cryoglobulin was absent, ruling out autoimmune systemic vasculitis. Initial lab results indicated well-controlled levels of calcium, iPTH, and phosphorus. A punch biopsy was performed to rule out calciphylaxis, which showed no calcium deposits, thrombi, or evidence of vasculitis.
Discussion
While current literature generally indicates the safety of midodrine, this case appears to be one of the few documented instances of midodrine-induced ischemic vascular injury observed in hemodialysis patients. Further research should prioritize discontinuing the medication to evaluate the persistence of symptoms. The primary aim of this report is to increase awareness of ischemic vascular injury as a potential side effect of midodrine and to encourage heightened vigilance among physicians.